2012-04-11T19:29:34-05:00 2011-06-30 SINGERLEWAK LLP 10960 WILSHIRE BLVD STE 700 LOS ANGELES CA 900243783 990 2010-07-01 952769432 VENICE FAMILY CLINIC VENI 3103928630 604 ROSE AVENUE VENICE CA 90291 ELIZABETH B FORER 3103928630 2012-03-27 1 LIOR TEMKIN 3104773924 2012-03-27 2010 2016-02-24 21:20:13Z ELIZABETH B FORER 604 ROSE AVENUE VENICE CA 90291 39510840 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. 20 20 268 1706 0 0 26260250 29119560 9052847 9689336 387705 190578 84160 54190 35784962 39053664 0 432536 0 0 16291349 17355743 230802 229678 1012023 16309321 19452466 32831472 37470423 2953490 1583241 20951691 23596088 2438304 3022093 18513387 20573995 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 32845615 432536 9689336 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 81,407 PRIMARY HEALTH CARE VISITS, 7,315 SPECIALTY CARE VISITS, 3,251 DENTAL VISITS, 7,511 MENTAL HEALTH CARE VISITS AND 7,862 HEALTH EDUCATION VISITS PROVIDED DURING THE YEAR ENDED JUNE 30, 2011.VENICE FAMILY CLINIC'S 25,321 PATIENTS IN YEAR ENDED JUNE 30, 2011 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. 32845615 1 1 0 1 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 1 121 0 1 268 1 0 0 0 0 0 1 1 0 0 0 0 X 20 20 0 0 1 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 SUSAN ADELMAN 1.00 X 0 0 0 MAYER B DAVIDSON MD 1.00 X 0 0 0 PAULA DAVIS 1.00 X 0 0 0 RICHARD DEARMOND MSW 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 STEWART SERADSKY 1.00 X 0 0 0 FLORA SANTACRUZ 1.00 X 0 0 0 LOURDES SERVIN 1.00 X 0 0 0 MARSHA TEMPLE ESQ 1.00 X 0 0 0 CARMEN THOMAS-PARIS 1.00 X 0 0 0 BRIAN D KAN MD 1.00 X X 0 0 0 YVONNE ASHLEY JOHNSON 1.00 X X 0 0 0 JEFFREY E SINAIKO 1.00 X X 0 0 0 ELIZABETH B FORER 40.00 X 166750 0 35424 FREDERICK W HORNBECK 40.00 X 123786 0 28291 CARMEN M IBARRA 40.00 X 116929 0 16952 LORETO S MELO 40.00 X 125429 0 33145 KAREN C LAMP 40.00 X 166563 0 36472 CATHERINE A CHAROUHAS 36.00 X 131844 0 24426 BARBARA F GROTTS 36.00 X 131198 0 33280 SAKURA LING KUO 40.00 X 141122 0 29216 SHARON NG 40.00 X 145549 0 34462 NORMA ROSALES 40.00 X 139533 0 27944 1388703 0 299612 24 0 1 0 JENSEN ZIGMAN CONSTRUCTION CO INC 10020 NATIONAL BLVD LOS ANGELES CA 90034 CONSTRUCTION & DEVELOPMENT 279875 WILLIAM L JONES 640 N SWEETZER AVENUE 11 LOS ANGELES CA 90048 CONSULTANT/DEVELOPMENT 231790 OCEAN PARK COMMUNITY CENTER 1453 16TH STREET SANTA MONICA CA 904042715 HOMELESS SERVICES 125752 3 901999 150000 6386061 21681500 14123326 29119560 MEDICARE/MEDICAID PYMT 621400 9689336 9689336 9689336 213493 213493 700 23615 -23615 700 -22915 -22915 433561 901999 433561 0 MISCELLANEOUS INCOME 900099 54190 54190 54190 39053664 9689336 0 244768 432536 432536 890841 349481 541360 11198182 9516256 1226457 455469 492336 418389 53922 20025 3871482 3289842 439703 141937 902902 736167 124816 41919 14430 14430 94537 94537 229678 229678 1030683 913434 41202 76047 298908 200561 95919 2428 516661 434797 79082 2782 155717 145464 7563 2690 19789 19789 651771 380459 254168 17144 190474 9328 181146 DONATED DRUGS AND PHARM 14171506 14171506 REPAIRS AND MAINTENANCE 541940 432498 94662 14780 MEDICAL SUP & REMOVAL 361154 361092 62 PHARMACEUTICAL AND LAB 317164 317164 LICENSES, FEES AND DUES 236225 33669 199824 2732 851507 702972 144143 4392 37470423 32845615 3612785 1012023 902 902 1666928 1483963 3545671 5353222 1014990 2463210 1267165 1206369 112142 114773 14147979 7301632 6731471 6846347 481252 5770 5694271 5602428 436899 519104 20951691 23596088 1130658 831776 1307646 2190317 2438304 3022093 X 7843307 8011238 6446023 8338700 4224057 4224057 18513387 20573995 20951691 23596088 X 1583241 477367 X 0 1 1 X 1 1 X 19029468 20501904 20031532 26260250 29119560 114942714 19029468 20501904 20031532 26260250 29119560 114942714 616000 676530 189764 369725 388782 2240801 8916427 3170970 9811834 11712807 12682222 46294260 9532427 3847500 10001598 12082532 13071004 48535061 66407653 284407 274636 158565 123217 213493 1054318 284407 274636 158565 123217 213493 1054318 104948 120588 51789 84160 54190 415675 19418823 20897128 20241886 26467627 29387243 116412707 0.57050 0.63180 0.00910 0.01000 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: 2006 OTHER REVENUE: $104,948 2007 OTHER REVENUE: $120,588 2008 OTHER REVENUE: $51,789 2009 OTHER REVENUE: $84,160 2010 OTHER REVENUE: $54,190 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 3682 1 3683 0 7365 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: 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. 4030445 575967 199760 4406652 3033757 750000 372368 125680 4030445 3824957 10700 -657819 144081 3033757 0.99570 0.00430 0 0 1363223 1363223 5991008 3351762 2639246 4805276 3139888 1665388 1988472 809982 1178490 6846347 DONATED PROPERTY 1394040 C UCLA EIP FUND 4017065 C UCLA STIP FUND 191323 C 5602428 PLEDGE LIABILITIES 557646 LINE OF CREDIT 1632671 2190317 39053664 37470423 1583241 477367 477367 2060608 43743655 477367 3544937 667687 4689991 39053664 0 39053664 41566095 3544937 550735 4095672 37470423 0 37470423 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, 2011, THE CLINIC DID NOT RECOGNIZE ANY AMOUNT IN POTENTIAL INTEREST AND PENALTIES ASSOCIATED WITH UNCERTAIN TAX POSITIONS. VFC'S INCOME TAX RETURNS REMAIN SUBJECT TO EXAMINATION FOR ALL TAX YEARS ENDED ON OR AFTER JUNE 30, 2007 WITH REGARD TO ALL TAX POSITIONS AND THE RESULTS REPORTED. THE FOUNDATION'S INCOME TAX RETURN REMAINS SUBJECT TO EXAMINATION FOR THE TAX YEAR ENDED ON OR AFTER JUNE 30, 2011 WITH REGARD TO ALL TAX POSITIONS AND RESULTS REPORTED. PART XII, LINE 2D - OTHER ADJUSTMENTS: AMOUNT REPORTED ON OTHER RETURN 463,803. SPECIAL EVENTS 203,884. PART XIII, LINE 2D - OTHER ADJUSTMENTS: AMOUNT REPORTED ON OTHER RETURN 346,851. SPECIAL EVENTS 203,884. X X X X X X 1 WILLIAM JONES 640 N SWEETZER AVE 11 LOS ANGELES CA 90048 VARIOUS 0 1335561 229678 1105883 1335561 229678 1105883 CA SILVER CIRCLE 1087387 749093 338294 114394 7500 216400 HOLIDAY MOVIE 88859 65975 22884 22883 2 159314 86931 72383 72384 1335560 901999 433561 114394 7500 311667 433561 0 0 INSURE THE UNINSURED PROJECT (ITUP) 2444 WILSHIRE BLVD SANTA MONICA CA 90403 274159194 501(C)(3) 432536 FMV PROJECT FUNDING X X 0 0 0 0 0 0 0 0 0 ELIZABETH B FORER 166750 0 0 0 0 0 0 0 35424 0 202174 0 0 0 FREDERICK W HORNBECK 123786 0 0 0 0 0 0 0 28291 0 152077 0 0 0 LORETO S MELO 119507 0 0 0 5922 0 0 0 33145 0 158574 0 0 0 KAREN C LAMP 166563 0 0 0 0 0 0 0 36472 0 203035 0 0 0 CATHERINE A CHAROUHAS 131844 0 0 0 0 0 0 0 24426 0 156270 0 0 0 BARBARA F GROTTS 131198 0 0 0 0 0 0 0 33280 0 164478 0 0 0 SAKURA LING KUO 141122 0 0 0 0 0 0 0 29216 0 170338 0 0 0 SHARON NG 145549 0 0 0 0 0 0 0 34462 0 180011 0 0 0 NORMA ROSALES 139533 0 0 0 0 0 0 0 27944 0 167477 0 0 0 X 5000 FAIR MARKET VALUE X 17 14118326 FAIR MARKET VALUE 0 0 1 0 NON REPORTING OF REVENUE: PART I, LINE 33: CLOTHING GETS DONATED TO US AND WE IN TURN GIVE IT TO OUR HOMELESS PATIENTS FORM 990, PART VI, SECTION A, LINE 4 THE VENICE FAMILY CLINIC BOARD OF DIRECTORS HELD A SPECIAL MEETING ON NOVEMBER 2, 2010 AT WHICH A NEW BOARD WAS SELECTED THAT WOULD BE IN COMPLIANCE WITH SECTION 330E COMMUNITY HEALTH CENTER BOARD REQUIREMENTS. AT THIS TIME, VENICE FAMILY CLINIC WAS IN THE PROCESS OF SUBMITTING AN APPLICATION FOR SECTION 330(E) COMMUNITY HEALTH CENTER FUNDING FROM THE FEDERAL GOVERNMENT. IN ORDER TO RECEIVE THIS FUNDING, THE CLINIC'S BOARD OF DIRECTORS NEEDED TO BE COMPLIANT WITH THE GOVERNANCE REQUIREMENTS FOR ORGANIZATIONS RECEIVING SECTION 330(E) FEDERAL FUNDING. THESE REQUIREMENTS INCLUDE THE FOLLOWING: -THE BOARD MUST HAVE A MINIMUM OF 9 AND A MAXIMUM OF 25 MEMBERS. -51% OF BOARD MEMBERS (AT LEAST A SIMPLE MAJORITY) MUST BE ACTIVE CONSUMERS (I.E. REGULAR PATIENTS) OF THE FUNDED ENTITY, MEANING THEY GET THEIR PRIMARY HEALTHCARE THERE. -CONSUMER BOARD MEMBERS MUST BE REPRESENTATIVE OF THE AGENCY'S PATIENT POPULATION AND BE RESIDENTS OF ITS SERVICE AREA. -NO MORE THAN HALF OF THE NON-CONSUMER MEMBERS MAY EARN MORE THAN 10% OF THEIR INCOME FROM THE HEALTH CARE INDUSTRY. (THE HEALTH CARE INDUSTRY IS EXTREMELY BROADLY DEFINED FOR PURPOSES OF THIS REGULATION.) -THE COMMUNITY HEALTH CENTER BOARD MUST HOLD MONTHLY MEETINGS. IN ADDITION TO RESTRUCTURING THE CLINIC'S BOARD, A SEPARATE 501(C)(3) ENTITY, THE VENICE FAMILY CLINIC FOUNDATION, WAS CREATED. THE FOUNDATION HAS A SEPARATE BOARD AND ITS MISSION "IS TO SUPPORT, THROUGH FINANCIAL AND IN-KIND CONTRIBUTIONS, PROVISION OF SERVICES AND COMMUNITY OUTREACH, THE MISSION OF VENICE FAMILY CLINIC." 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 GAINS ON INVESTMENTS: 477,367. 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)(II) 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