2013-03-22T18:21:14-05:00 2012-06-30 952302617 SINGERLEWAK LLP 10960 WILSHIRE BLVD STE 700 LOS ANGELES CA 900243783 990 2011-07-01 952769432 VENICE FAMILY CLINIC VENI 3103928630 604 ROSE AVENUE VENICE CA 90291 ELIZABETH B FORER 3103928630 2013-03-18 1 NANAZ BENYAMINI P00666808 3104773924 2013-03-18 2011 2016-02-25 16:41:14Z ELIZABETH B FORER 604 ROSE AVENUE VENICE CA 90291 37526061 0 X HTTP://VENICEFAMILYCLINIC.ORG/ X 1970 CA VENICE FAMILY CLINIC IS A PRIVATE, NONPROFIT, COMMUNITY- BASED FREE CLINIC. FOUNDED IN 1970 TO MEET THE HEALTH CARE NEEDS OF THE LOW-INCOME RESIDENTS OF VENICE AND THE SURROUNDING COMMUNITY, THE CLINIC'S MISSION IS TO PROVIDE FREE, QUALITY HEALTH CARE TO PEOPLE IN NEED. 18 18 268 1955 0 0 29119560 26310106 9689336 9303267 190578 702351 54190 64740 39053664 36380464 432536 7463 0 0 17355743 18562730 229678 121750 1074462 19452466 19422592 37470423 38114535 1583241 -1734071 23596088 22564245 3022093 3946259 20573995 18617986 X THE VENICE FAMILY CLINIC WAS FOUNDED IN 1970 BY PHILIP ROSSMAN, MD AND CO-FOUNDER MAYER B. DAVIDSON, MD. 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. TODAY, THE SMALL CLINIC THAT THEY BEGAN IN A TINY STOREFRONT HAS GROWN INTO AMODEL OF CARE AND THE LARGEST FREE CLINIC IN THE UNITED STATES. ALTHOUGH WE WERE FOUNDED AS A "TEMPORARY, STOP-GAP MEASURE," WE ARE STILL HERE AFTER 41 YEARS BECAUSE THE NUMBER OF UNINSURED CHILDREN AND ADULTS CONTINUES TO GROW, AND NO OTHER SOLUTION FOR HOW BEST TO PROVIDE (AND PAY FOR) HEALTH CARE TO THE UNINSURED HAS EMERGED. FOR OUR PATIENTS, THE VENICE FAMILY CLINIC IS A BEACON OF HOPE AND HEALING. TO THE LARGER COMMUNITY, THE CLINIC HAS PROVEN ITSELF TO BE AN INNOVATIVE, EFFICIENT AND VIABLE RESPONSE TO THE NEED FOR PRIMARY HEALTH CARESERVICES FOR THE WORKING POOR OF LOS ANGELES COUNTY. 0 0 33520822 7463 9303267 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 79,154 PRIMARY HEALTH CARE VISITS, 7,160 SPECIALTY CARE VISITS, 4,464 DENTAL VISITS, 7,509 MENTAL HEALTH CARE VISITS AND 7,982 HEALTH EDUCATION VISITS PROVIDED DURING THE YEAR ENDED JUNE 30, 2012.VENICE FAMILY CLINIC'S 23,802 PATIENTS IN YEAR ENDED JUNE 30, 2012 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. 33520822 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 99 0 1 268 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 1 0 CA X LORETO S MELO 3106647902 604 ROSE AVENUE VENICE CA 90291 MAYER B DAVIDSON MD 1.00 X 0 0 0 PAULA DAVIS 1.00 X 0 0 0 AIME ESPINOSA 1.00 X 0 0 0 WILLIAM FLUMENBAUM 1.00 X 0 0 0 LUIS GALVEZ 1.00 X 0 0 0 REVEREND LYNDA D GRAY 1.00 X 0 0 0 CRISPIN JIMENEZ 1.00 X 0 0 0 NEIL H PARKER MD 1.00 X 0 0 0 BILL RESNICK MD 1.00 X 0 0 0 PAUL M SABEN MBA 1.00 X 0 0 0 FLORA SANTACRUZ 1.00 X 0 0 0 LOURDES SERVIN 1.00 X 0 0 0 STEWART SERADSKY 1.00 X 0 0 0 CARMEN THOMAS-PARIS 1.00 X 0 0 0 LEISA WU 1.00 X 0 0 0 BRIAN D KAN MD 4.00 X X 0 0 0 YVONNE ASHLEY JOHNSON 2.00 X X 0 0 0 JEFFREY E SINAIKO 2.00 X X 0 0 0 ELIZABETH B FORER 40.00 X 176230 0 42582 FREDERICK W HORNBECK 40.00 X 130885 0 35794 CARMEN M IBARRA 40.00 X 128233 0 21099 LORETO S MELO 40.00 X 148479 0 38083 KAREN C LAMP 40.00 X 176033 0 43339 BLANCA ANDRES 36.00 X 131428 0 22775 CATHERINE A CHAROUHAS 36.00 X 135933 0 28772 SAKURA LING KUO 40.00 X 150914 0 34935 MARGARITA LOEZA 40.00 X 139020 0 33417 SHARON NG 40.00 X 157192 0 41147 1474347 0 341943 10 0 1 0 NEXTGEN HEALTHCARE INFORMATION SYSTEMS PO BOX 511449 LOS ANGELES CA 900518004 TECHNOLOGY SERVICES 310716 WILLIAM L JONES 640 N SWEETZER AVENUE 11 LOS ANGELES CA 90048 FUNDRAISING CONSULTANT 234000 JENSENZIGMAN CONSTRUCTION CO INC 10020 NATIONAL BOULEVARD LOS ANGELES CA 90034 CONSTRUCTION/DEVELOPMENT 189416 OCEAN PARK COMMUNITY CENTER 1453 16TH STREET SANTA MONICA CA 904042715 HOMELESS SERVICES 131853 WEISS FAMILY LIMITED PARTNERSHIP INC 904 SILVER SPUR ROAD 422 ROLLING HILLS ESTATE CA 90274 RENTAL OF COMMERCIAL BUILDING 101780 5 1054704 210000 5180344 19865058 14217335 26310106 MEDICARE/MEDICAID PYMT 621400 9303267 9303267 9303267 213009 213009 1430459 104725 836392 -104725 594067 489342 489342 204480 1054704 204480 0 MISCELLANEOUS INCOME 900099 64740 64740 64740 36380464 9303267 0 767091 7463 7463 888484 348972 539512 12760229 10697347 1453956 608926 839490 714013 88648 36829 3144323 2667227 340775 136321 930204 768858 122751 38595 2290 2290 83305 83305 121750 121750 919872 884364 8833 26675 403225 337880 56903 8442 480542 403119 74274 3149 152612 134090 17146 1376 68037 68037 674872 614204 42527 18141 207947 7048 200899 DONATED DRUGS AND PHARM 14628738 14628738 REPAIRS AND MAINTENANCE 479158 382154 86571 10433 MEDICAL SUP & REMOVAL 270480 270480 PHARMACEUTICAL AND LAB 201300 201300 850214 453565 332824 63825 38114535 33520822 3519251 1074462 902 802 1483963 1413981 5353222 5664436 2463210 2530237 1206369 800707 114773 114959 14455544 7974236 6846347 6481308 5770 3539 5602428 5080792 519104 473484 23596088 22564245 831776 188433 2190317 3757826 3022093 3946259 X 8011238 7239379 8338700 6104550 4224057 5274057 20573995 18617986 23596088 22564245 X -1734071 -221938 X 0 1 1 X 1 1 X 20501904 20031532 26260250 29119560 26310106 122223352 8198592 9491046 9052847 9689336 9303267 45735088 28700496 29522578 35313097 38808896 35613373 167958440 676530 189764 369725 388782 375046 1999847 0 676530 189764 369725 388782 375046 1999847 165958593 274636 158565 123217 213493 213009 982920 274636 158565 123217 213493 213009 982920 120588 51789 84160 54190 64740 375467 29095720 29732932 35520474 39076579 35891122 169316827 0.98020 0.57050 0.00580 0.00910 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: 2007 OTHER REVENUE: $120,588 2008 OTHER REVENUE: $51,789 2009 OTHER REVENUE: $84,160 2010 OTHER REVENUE: $54,190 2011 OTHER REVENUE: $64,740 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 938 1 938 0 1876 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: OVER THE PAST YEAR, VENICE FAMILY CLINIC'S IN-HOUSE ADVOCACY TEAM MET MONTHLY WITH THE BOARD COMMITTEE OVERSEEING ADVOCACY WORK, AND FOCUSED ON HEALTH CARE ISSUES AT THE LOCAL, STATE AND NATIONAL POLICY LEVELS. LOCALLY, WE WORKED WITH THE COUNTY DEPARTMENT OF HEALTH TO HELP IMPLEMENT A NEW PROGRAM THAT WILL PROVIDE COVERAGE TO THE LOWEST INCOME MEMBERS OF OUR COMMUNITY. AT THE STATE LEVEL, WE JOINED WITH THE CALIFORNIA PRIMARY CARE ASSOCIATION AND OTHER AGENCIES TO OPPOSE BUDGET CUTS TO HEALTH CARE AND SOCIAL SERVICE PROGRAMS IMPACTING THE POOR. AT THE NATIONAL LEVEL, WE ENLISTED STAFF, BOARD MEMBERS AND PATIENTS IN PHONE AND E-MAIL CAMPAIGNS TO ENCOURAGE MEMBERS OF CONGRESS TO CONTINUE FUNDING FOR COMMUNITY HEALTH CENTERS AND MEDICAID/MEDICARE. IN ADDITION, SEVERAL ELECTED OFFICIALS ON THE STATE AND FEDERAL LEVELS WERE INVITED TO TOUR THE CLINIC AND LEARN MORE ABOUT THE NEEDS OF THE MEDICALLY UNDERSERVED AND THE PROVIDERS TREATING THEM. 4406652 1050000 -74201 203714 5178737 4030445 575967 199760 4406652 3033757 750000 372368 125680 4030445 3824957 10700 -657819 144081 3033757 1.00000 0 0 1363223 1363223 6002656 3366079 2636577 4842898 3483963 1358935 2246767 1124194 1122573 6481308 UCLA EIP FUND 3887491 F UCLA STIP FUND 1193301 F 5080792 LINE OF CREDIT 3000000 LONG-TERM LOAN 203093 SHORT-TERM NOTES PAYABLE 554733 3757826 36380464 38114535 -1734071 -221938 -221938 -1956009 41052317 -221938 4154948 738843 4671853 36380464 0 36380464 42866572 4154948 597089 4752037 38114535 0 38114535 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 2012, THE CLINIC DID NOT RECOGNIZE ANY AMOUNT IN POTENTIAL INTEREST AND PENALTIES ASSOCIATED WITH UNCERTAIN TAX POSITIONS. THE CLINIC'S INCOME TAX RETURNS REMAIN SUBJECT TO EXAMINATION FOR ALL TAX YEARS ENDED ON OR AFTER JUNE 30, 2009 WITH REGARD TO ALL TAX POSITIONS AND THE RESULTS REPORTED. PART XII, LINE 2D - OTHER ADJUSTMENTS: AMOUNT REPORTED ON OTHER RETURN 534,363. SPECIAL EVENTS 204,480. PART XIII, LINE 2D - OTHER ADJUSTMENTS: AMOUNT REPORTED ON OTHER RETURN 392,609. SPECIAL EVENTS 204,480. X X X X X X X 1 WILLIAM JONES 640 N SWEETZER AVE 11 LOS ANGELES CA 90048 VARIOUS 0 1259184 121750 1137434 1259184 121750 1137434 CA SILVER CIRCLE 1012558 854934 157624 111515 15325 30784 HOLIDAY MOVIE 84345 77028 7317 7317 2 162281 122742 39539 39539 1259184 1054704 204480 111515 15325 77640 204480 0 0 INSURE THE UNINSURED PROJECT (ITUP) 2444 WILSHIRE BLVD SANTA MONICA CA 90403 274159194 501(C)(3) 7463 0 FMV PROJECT FUNDING 1 X X 0 0 0 0 0 0 0 0 0 ELIZABETH B FORER 176230 0 0 0 0 0 9706 0 32876 0 218812 0 0 0 FREDERICK W HORNBECK 130885 0 0 0 0 0 7109 0 28685 0 166679 0 0 0 LORETO S MELO 121613 0 26866 0 0 0 6720 0 31363 0 186562 0 0 0 KAREN C LAMP 176033 0 0 0 0 0 9695 0 33644 0 219372 0 0 0 BLANCA ANDRES 131428 0 0 0 0 0 7238 0 15537 0 154203 0 0 0 CATHERINE A CHAROUHAS 135933 0 0 0 0 0 7499 0 21273 0 164705 0 0 0 SAKURA LING KUO 150914 0 0 0 0 0 8305 0 26630 0 185849 0 0 0 MARGARITA LOEZA 139020 0 0 0 0 0 7657 0 25760 0 172437 0 0 0 SHARON NG 157192 0 0 0 0 0 8646 0 32501 0 198339 0 0 0 X 15 14217335 FAIR MARKET VALUE 0 0 1 0 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -221,938. 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) 509(A)(3) TYPE III N/A 0 0 0 1 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 150000 CASH