WESTMINSTER FREE CLINIC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
WESTMINSTER FREE CLINIC (EIN 77-0563241)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-09-13
IRS object ID
201102569349300110
Schema version
2010v3.2
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)
Timestamp2011-09-13T09:24:19-07:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1SOARES SANDALL BERNACCHI AND PETROVICH LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1405 E ESPLANADE DR STE 300AddressLine1
CityOXNARDCity
StateCAState
ZIP Code930362116ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN770563241EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1WESTMINSTER FREE CLINICBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlWESTNameControl
Phone8052418366Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line15560 NAPOLEON AVENUEAddressLine1
CityOAK PARKCity
StateCAState
ZIP Code91377ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLISA SAFAEINILIName
TitleExecutive DirectorTitle
Date Signed2011-09-13DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameSharon Iler RobertsName
Phone8054857965Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonLISA SAFAEINILINameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line15560 NAPOLEON AVENUEAddressLine1
CityOAK PARKCity
StateCAState
ZIP Code91377ZIPCode
FieldValueIRS element (for citing)
Gross Receipts697083GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501c3XOrganization501c3
Web Sitewww.westminsterclinic.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2000YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE FREE MEDICAL CARE TO THE HOMELESS AND UNINSURED WORKING POOR RESIDENTS OF EAST VENTURA COUNTY, CA.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees5TotalNbrEmployees
Total Nbr Volunteers200TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year439069ContributionsGrantsPriorYear
Contributions Grants Current Year691101ContributionsGrantsCurrentYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year4387InvestmentIncomePriorYear
Investment Income Current Year5982InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year443456TotalRevenuePriorYear
Total Revenue Current Year697083TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year290041SalariesEtcPriorYear
Salaries Etc Current Year276431SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year189153OtherExpensePriorYear
Other Expenses Current Year235522OtherExpensesCurrentYear
Total Expenses Prior Year479194TotalExpensesPriorYear
Total Expenses Current Year511953TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-35738RevenuesLessExpensesPriorYear
Revenues Less Expenses CY185130RevenuesLessExpensesCY
Total Assets BOY759221TotalAssetsBOY
Total Assets EOY943466TotalAssetsEOY
Total Liabilities BOY1324TotalLiabilitiesBOY
Total Liabilities EOY439TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY757897NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY943027NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO PROVIDE FREE MEDICAL CARE TO THE HOMELESS AND UNINSURED WORKING POOR RESIDENTS OF EAST VENTURA COUNTY, CA.MissionDescription
Significant New Program ServicestrueSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense187527Expense
DescriptionPrimary Care/Clinical ServicesOffered to approximately 70 patients each clinic night by volunteer doctors and nurses from 5 pm to 10 pm. Services are provided on a first-come-first-serve basis, except for children, who take priority. Doctors services are non-invasive and include diagnosis, writing prescriptions and making referrals. Lab tests, and diagnostic tests are provided by the clinic so the doctors have more information. Other primary health care services include: bi-monthly Immunizations, flu shots and TB testing, weekly Blood Pressure and Blood Glucose testing, Dental screening and education, Chiropractic & Physical Therapy services, Mental Health Counseling, nutrition counseling, referrals, a family literacy program called Reach Out and Read, Health Education classes and referrals for free glasses and mammograms. Medical volunteers include doctors, nurse practitioners, nurses, pharmacists, chiropractors, physical therapists, dentists, phlebotomists, medical technologists, psychologists, counselors, health educators and a dietitian. All clinic services listed are free-of-charge.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense139378Expense
DescriptionTeen Healthcare Training & Internship ProgramThis program offers local teens an opportunity to be mentored by healthcare professionals volunteering at the clinic to improve the medical welfare of fellow community members who do not have health insurance and access to healthcare. Over 74 local High School students from Newbury Park, Thousand Oaks, Moorpark, Simi Valley and Westlake High Schools (50% are minority low income teens who have dreams of pursuing careers in healthcare) have the opportunity to volunteer and assist directly with the delivery of patient services, and also receive education, fieldtrips, training in healthcare fields, as well as mentoring and job shadowing opportunities. It is a 2-year commitment for the student, with most staying longer. The students enjoy helping their community and being part of a medical team. Most are interested in becoming nurses. 95% to 100% of our graduating students are attending college. For many, they are the first in their family to do so.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense64007Expense
DescriptionCase ManagementThis program creates linkages to community resources, leverages health care at a discounted rate or for free from local medical specialists, dentists and optometrists. For example our optometrists provide free eye exams and glasses for the children and adults we refer to them. We partner with local schools to make sure all children receive the vision care and glasses they need to succeed. In addition, $5,000 in root canal procedures was donated by our local endodontists who partner with us. The Case Manager also sets up patient appointments and helps patients follow through with their plan of care provided by our doctors. Eligible patients are also assisted with the paperwork related to Medi-Cal, Medicare, SSI, ACE, and Healthy Families insurance programs. It makes it possible for some patients to obtain insurance they did not think they were eligible for, or for which they didnt know how to fill out the correct papers. The Case Manager also creates partnerships with pharmaceutical and medical supply companies (eg. the Patient Assistance Program (PAP) ) to access free medications and other supplies for patients with chronic health conditions. During the year ended December 31, 2010, the Clinic received a total of $574,338 in in-kind donated professional medical services and $240,000 in donated rent and utilities.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp72298TotalOfOtherProgramServiceExp
Total Program Service Expense463210TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredfalseScheduleJRequired
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 ContributionstrueDeductibleNonCashContributions
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 With10969NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees5NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Form8886 T FiledfalseForm8886TFiled
Non Deductible ContributionsfalseNonDeductibleContributions
Non Deductible DisclosurefalseNonDeductibleDisclosure
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Quid Pro Quo DisclosurefalseQuidProQuoDisclosure
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
Form720 FiledfalseForm720Filed
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Policies Reference ChaptersfalsePoliciesReferenceChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementfalseRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledCAStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonKAREN YTURRALDENamePerson
Telephone Number8053836636TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line15288 MEADOWRIDGE CTAddressLine1
CityCAMARILLOCity
StateCAState
ZIP Code93012ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (11 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
AMANDA VINSON ESQ
Secretary2.50XX000
JUDY JONES RN
Director2.50X000
MANUEL VALDEZ
CFO2.50XX000
JULIE MARTIN
Director2.50X000
DR STEVEN KAMAJIAN
President2.50XX000
THERESA MICHELINI Pharm D
Director2.50X000
CYNTHIA B HUGHES EdD PNP
Director2.50X000
CYNTHIA M VINSON MFT
CHIEF ACT. OFFI2.50XX000
ADELA AQUINO
COMMUNITY REP.2.50X000
WILLIAM T VINSON ESQ
Chairman2.50XX000
LISA SAFAEINILI
Executive Direc60.00X10671700
FieldValueIRS element (for citing)
Total Reportable Comp From Org106717TotalReportableCompFromOrg
Number Individuals GT100 K1NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Federated Campaigns14690FederatedCampaigns
Government Grants162352GovernmentGrants
All Other Contributions514059AllOtherContributions
Noncash Contributions61458NoncashContributions
Total Contributions691101TotalContributions
Total Program Service Revenue0TotalProgramServiceRevenue

Investment Income InvestmentIncome

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Total Revenue Column5982TotalRevenueColumn
Exclusion$5,982ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

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Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

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Total Revenue Column0TotalRevenueColumn

Net Rental Income Or Loss NetRentalIncomeOrLoss

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Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

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Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

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Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

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Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

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Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

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Total Revenue Column697083TotalRevenueColumn
Exclusion$5,982ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

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Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

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Total0Total

Foreign Grants ForeignGrants

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Total0Total

Benefits To Members BenefitsToMembers

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Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

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Total106717Total
Program Services88931ProgramServices
Management And General17786ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

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Total0Total

Other Salaries And Wages OtherSalariesAndWages

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Total133067Total
Program Services133067ProgramServices

Pension Plan Contributions PensionPlanContributions

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Total0Total

Other Employee Benefits OtherEmployeeBenefits

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Total15872Total
Program Services11857ProgramServices
Management And General4015ManagementAndGeneral

Payroll Taxes PayrollTaxes

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Total20775Total
Program Services19333ProgramServices
Management And General1442ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

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Total0Total

Fees For Services Legal FeesForServicesLegal

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Total0Total

Fees For Services Accounting FeesForServicesAccounting

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Total22195Total
Management And General22195ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

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Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

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Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

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Total0Total

Fees For Services Other FeesForServicesOther

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Total37436Total
Program Services37436ProgramServices

Advertising Advertising

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Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2553Total
Program Services2232ProgramServices
Management And General321ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total831Total
Program Services274ProgramServices
Management And General557ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total0Total

Travel Travel

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Total1695Total
Program Services1695ProgramServices

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

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Total0Total

Conferences Meetings ConferencesMeetings

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Total4925Total
Program Services4925ProgramServices

Interest Interest

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Total15Total
Management And General15ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

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Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total682Total
Management And General682ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total13119Total
Program Services13119ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
LABORATORY/DIAGNOSTIC88518851
MEDICAL SUPPLIES1429214292
X-RAY/CATSCAN/MRI1830518305
PHARMACEUTICALS2861228612
DONATED SUPPLIES EXPENSE6145861458

All Other Expenses AllOtherExpenses

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Total20553Total
Program Services18823ProgramServices
Management And General1730ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total511953Total
Program Services463210ProgramServices
Management And General48743ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY207216BOY
EOY385514EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY548163BOY
EOY555145EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
EOY0EOY

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)
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
EOY0EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis3497LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec690LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY3842BOY
EOY2807EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

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)
BOY759221BOY
EOY943466EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1324BOY
EOY439EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1324BOY
EOY439EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY757897BOY
EOY943027EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY757897BOY
EOY943027EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY759221BOY
EOY943466EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses185130ReconcilationRevenueExpenses
Method Of Accounting CashXMethodOfAccountingCash
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedfalseFSAudited
Audit CommitteefalseAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired
Federal Grant Audit PerformedfalseFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years711102CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years730326CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years747528CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year400474CurrentTaxYearMinus1Year
Current Tax Year691101CurrentTaxYear
Total3280531Total

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 Years711102CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years730326CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years747528CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year400474CurrentTaxYearMinus1Year
Current Tax Year691101CurrentTaxYear
Total3280531Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total398977AmountsSubstContributorsTotal
Public Support Total1702881554PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years17472CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20184CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years12778CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4387CurrentTaxYearMinus1Year
Current Tax Year5982CurrentTaxYear
Total60803Total

Net UBI NetUBI

FieldValueIRS element (for citing)
Total0Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Total Support3341334TotalSupport
Public Support Pertcentage1700.86240PublicSupportPertcentage170
Public Support Pertcent Prior Year0.80440PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis3497OtherCostOrOtherBasis
Depreciation690Depreciation
Book Value2807BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2807TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionCREDIT CARDS PAYABLEDescription
Amount$439Amount
FieldValueIRS element (for citing)
Total Of Amounts439TotalOfAmounts

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions10000NumberOfContributions
Noncash Contribs Rptd F99061458NoncashContribsRptdF990
Method Of Determining RevenuesFMVMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part VI, Line 19Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableFINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. IN ADDITION, THE FINANCIAL STATEMENTS ARE MADE AVAILABLE ONLINE AT: http://www2.guidestar.org/
Form 990, Part VI, Line 15bForm 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesThe Organization's board of directors review and approve the compensation paid to all of the Organization's employees during the board of director's budget meetings or whenever a new officer or key employee is hired.
Form 990, Part VI, Line 11Form 990, Part VI, Line 11: Form 990 Review ProcessA COPY OF THE 990 IS PRESENTED TO AND REVIEWED BY THE ORGANIZATION'S BOARD OF DIRECTORS, PRESIDENT AND EXECUTIVE DIRECTOR. IN ADDITION, A COPY OF THE FINAL 990 IS PROVIDED TO EACH BOARD MEMBER.
Form 990, Part VI, Line 2Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, EtThe board of directors William Vinson, Cynthia Vinson and Amanda Vinson are related.
Form 990, Part III, Line 4dForm 990, Part III, Line 4d : Other Program Services DescriptionOTHER PROGRAM SERVICES 4: Mental Health Counseling & Violence Prevention Paraprofessional Training ProgramThe counselor is Spanish and English speaking. Family, group sessions and individual counseling is provided during clinic hours. The counselor works closely with WFC physicians to address health conditions brought on by psychological issues. Client visits average 4-5 sessions. The Violence Prevention Paraprofessional Training Program is designed to train women and teenage girls from our patient community to become community educators. Participants are enrolled in an 8-week training course where they learn family violence prevention techniques, signs of mental health issues like depression, and suicide and domestic violence prevention. They are then placed into teaching groups where they are mentored and supervised as they lead groups in their community and teach others what they have learned. These classes are currently taught in Spanish and empower the participants to be leaders and teachers. The number of paraprofessional community educators continues to grow as more people graduate from the program. The program empowers families who may be in domestic violence situations to help themselves, their children and their community. The program is offered where parents naturally congregate. OTHER PROGRAM SERVICES 5: Diabetes Management & Education Program Including Community Outreach This program assists parents who have Type 2 diabetes with education and early treatment. The purpose of this program is also to help prevent children from getting diabetes like their parents. High school interns and a college student work in partnership with the bi-lingual health educator and dietitian to implement the program. Program participants are encouraged to get involved too. While they are helping they are also learning how they can improve their own family's health. The program includes: 1) personal dietary and exercise planning, goal setting and monitoring, 2)quarterly lab tests 3) weekly glucose finger sticks 4) weight and circumference measures, 5)weekly nutrition classes and food demonstrations, 6) one-on-one counseling with the dietitian, and 7) free medications, glucometer and test strips. All services are provided in Spanish and English. The need to identify people earlier with chronic disease issues like diabetes and high blood pressure has been evident for a long time. Through WFC's Community Outreach Program, it partners with the business community who have uninsured employees at their workplace (E-HIP)and locations nearby where people are already going (e.g. the laundry mat, Latino markets) to provide free blood pressure, and blood sugar screening as well as health education and resource referral. We have also been able to implement environmental change strategies (HEAL) (e.g. Latino markets offering diabetic friendly food choices that we are telling the patients they should eat) so clients are actually able to change their eating habits the way the doctors, dietitian and health educators at our clinic classes are telling them to (e.g. drink 1% or skim milk instead of whole milk). Our teen promotores interns who are already trained interns at our clinic are involved in all aspects of the program planning, marketing, evaluation, assessment and direct service. The students are instrumental in the programs success. A bi-lingual health educator runs the program and we have many stories of people with blood sugars over 400 (200 or lower is acceptable for non-fasting persons) and people with very high blood pressure who did not know about their serious health situation until they attended one of our screenings. The majority are now patients at our free clinic and getting their health conditions under control.
Form 990, Part III, Line 2Form 990, Part III, Line 2: New ServicesDiabetic Clinic:In October 2010 the Diabetic clinic was established to provide more comprehensive care for our diabetic patients. It is a monthly clinic that includes a physician visit, retinopathy screening (which is provided by an Ophthalmologist), exercise, dietetic counseling, and foot care by a podiatrist. This clinic was added to our existing services. In addition to wanting to help patients get their blood sugars under control, we also wanted to increase the capacity of our clinic. The diabetic clinic makes it possible for us to see more patients then we were able to before.
Client Note 1 - Reconciliation from books to Form 990Book revenue $ 1,511,421 Book expenses $ 1,326,291Less:donated services Less: donated services and facilities (814,338) and facilities (814,338) --------- --------990 Revenue $ 697,083 990 Expenses $ 511,953 ========= ========Revenue Per 990 $ 697,083 Expenses Per 990 $ 511,953Less: In-Kind Supplies (61,458) Less: In-Kind Supplies (61,458) ---------- --------Cash Basis Revenue $ 635,625 Cash Basis Expenses $ 450,495 ========= =========

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