2011-03-22T17:01:18-05:00 2010-06-30 SINGERLEWAK LLP 10960 WILSHIRE BLVD SUITE 700 LOS ANGELES CA 900243783 990 2009-07-01 952769432 VENICE FAMILY CLINIC VENI 3103928630 604 Rose Avenue Venice CA 90291 ELIZABETH B FORER 3103928630 2011-03-08 1 Lior Temkin 3104773924 2011-03-08 2009 2016-02-24 21:20:13Z ELIZABETH B FORER 604 ROSE AVENUE VENICE CA 90291 36563582 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. 42 42 268 2096 0 0 20031532 26260250 9491046 9052847 -109871 387705 51789 84160 29464496 35784962 0 0 16147444 16291349 225554 230802 1151136 14069452 16309321 30442450 32831472 -977954 2953490 17101641 20951691 1605086 2438304 15496555 18513387 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 33 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 28080952 9052847 The Clinic serves as a family doctor, 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 80,290 primary health care visits, 8,550 specialty care visits, 2,296 dental visits and 8,188 mental health care visits, and 7,138 health education visits.The Clinic's 24,413 patients in 2010 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 Southern California. 28080952 1 1 0 1 0 0 0 0 1 1 1 0 0 0 0 0 0 1 1 0 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 99 0 1 268 1 0 0 0 0 0 1 1 0 0 0 42 42 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X X LORETO S MELO 3106647902 604 ROSE AVENUE VENICE CA 90291 JIMMY H HARA MD 1.00 X 0 0 0 Ashley Johnson 1.00 X 0 0 0 Brian D Kan MD 1.00 X 0 0 0 Jeffrey E Sinaiko 1.00 X 0 0 0 Susan Adelman 1.00 X 0 0 0 Carol Archie MD 1.00 X 0 0 0 NEAL AXELROD 1.00 X 0 0 0 Neal Baer MD 1.00 X 0 0 0 Lowell C Brown Esq 1.00 X 0 0 0 RICK BRADLEY 1.00 X 0 0 0 Mayer B Davidson MD 1.00 X 0 0 0 AIME ESPINOSA 1.00 X 0 0 0 Mose J Firestone PhD LCSW 1.00 X 0 0 0 Susan Fleischman MD 1.00 X 0 0 0 William Flumenbaum 1.00 X 0 0 0 Chester Griffiths MD FACS 1.00 X 0 0 0 Joanne Jubelier PhD 1.00 X 0 0 0 Constance Lawton 1.00 X 0 0 0 Deborah Laub 1.00 X 0 0 0 Lou Lazatin 1.00 X 0 0 0 Harley Liker MD MBA 1.00 X 0 0 0 Tracey Loeb 1.00 X 0 0 0 Gail Margolis Esq 1.00 X 0 0 0 Frank Matricardi Dr PH 1.00 X 0 0 0 Viren Mehta 1.00 X 0 0 0 Wendy Smith Meyer PhD LCSW 1.00 X 0 0 0 William D Parente 1.00 X 0 0 0 HUTCH PARKER 1.00 X 0 0 0 Neil H Parker MD 1.00 X 0 0 0 Bill Resnick MD MBA 1.00 X 0 0 0 DAVID RUBENSON 1.00 X 0 0 0 Paul Saben 1.00 X 0 0 0 Fern Seizer 1.00 X 0 0 0 Alan Sieroty 1.00 X 0 0 0 MARSHA TEMPLE ESQ 1.00 X 0 0 0 Russel Tyner AIA 1.00 X 0 0 0 Michael S Wilkes MD PhD 1.00 X 0 0 0 LEISA WU 1.00 X 0 0 0 Ruth Bloom 1.00 X 0 0 0 Daniel Hillman MD 1.00 X 0 0 0 Karl A Keener Esq 1.00 X 0 0 0 Ruth Moss 1.00 X 0 0 0 ELIZABETH B FORER 40.00 X 163882 0 28877 FREDERICK W HORNBECK 40.00 X 123786 0 23597 CARMEN M IBARRA 40.00 X 124191 0 13210 LORETO S MELO 40.00 X 125000 0 25153 MARY RICHERT-UNTIL 0510 40.00 X 93124 0 16274 KAREN C LAMP 40.00 X 163698 0 29190 SAKURA LING KUO 40.00 X 140382 0 23855 MARGARITA LOEZA 40.00 X 128782 0 22765 sharon ng 40.00 X 145549 0 27841 NORMA ROSALES 40.00 X 138494 0 22658 miriam padilla 40.00 X 126463 0 18872 1473351 0 252292 22 0 1 0 JENSEN ZIGMAN CONSTRUCTION CO INC 10020 National Blvd los ANGELES CA 90034 construction & development 585984 WILLIAM L JONES 640 N SWEETZER AVENUE 11 LOS ANGELES CA 90048 CONSULTANT/DEVELOPMENT 221748 Ocean Park Community Center 1453 16th street santa monica CA 904042715 homeless services 149393 3 1279334 5397317 19583599 10915795 26260250 MEDICARE/MEDICAID PAYM 621400 9052847 9052847 9052847 123217 123217 691685 422197 5000 269488 -5000 264488 264488 351423 1279334 351423 0 MISCELLANEOUS INCOME 900099 84160 84160 84160 35784962 9052847 0 471865 1728178 1137000 591178 10052449 8177675 1290147 584627 3629812 3019661 435481 174670 880910 699840 136331 44739 23756 23756 68696 68696 230802 230802 940638 889083 46138 5417 275261 178337 92535 4389 485084 371707 110022 3355 133407 119404 10380 3623 28073 28073 642837 438515 185033 19289 179280 8119 171161 DONATED DRUGS AND PHARM 11313612 11313612 Repairs and maintenance 419293 321134 85724 12435 MEDICAL SUPPLIES REMOVA 315931 315931 GRANT EQUIPMENT 294321 278543 15006 772 PHARMACEUTICAL AND LAB 274318 274318 914814 538073 309723 67018 32831472 28080952 3599384 1151136 1165 902 1020723 1666928 1625636 3545671 964353 1014990 1656585 1267165 114549 112142 13727830 6996359 6435841 6731471 480728 481252 4427797 5694271 374264 436899 17101641 20951691 547440 1130658 1057646 1307646 1605086 2438304 X 7184628 7843307 4837870 6446023 3474057 4224057 15496555 18513387 17101641 20951691 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 1 1 0 0 0 0 1 1680 1 1680 0 3360 0 Part I-A, Line 1: Organizations Direct and Indirect Political Campaign Activities: Over the past year, Venice Family Clinic's advocacy work focused on health care issues at the local, state and nationaL policy levels. Locally, we advocated for increased accessibility to specialty and mental health care for our patients. 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. At the national level, we met with local congressional members and their staff, educating them on the needs of providers of primary health care for the uninsured and underserved populations and the patients themselves. We also worked to help promote national health care reform, including advising our elected officials on the proposed health care reform bill. In addition, we formed an in-house advocacy team, comprised of five staff members and several interns, that have been meeting monthly. To date this group has focused on voter registration and creating an advocacy database. Part II-B, Line 1i: Explanation of Other Lobbying Activities: DURING THIS YEAR, THE CLINIC'S ADVOCACY EFFORTS FOCUSED ON HEALTH CARE ISSUES AT THE LOCAL, STATE AND FEDERAL POLICY LEVELS. AT ALL LEVELS OF GOVERNMENT, WE WORKED TO PROVIDE AND PRESERVE ACCESS TO HEALTH CARE SERVICES FOR THE LOWEST INCOME MEMBERS OF OUR COMMUNITY AS WELL AS TO EDUCATE OUR ELECTED OFFICIALS ABOUT THE PLIGHT OF THE MEDICALLY UNDERSERVED AND THE CHALLENGES FACING THOSE TREATING THEM. AT THE STATE LEVEL, WE MET WITH ELECTED REPRESENTATIVES IN THE STATE SENATE AND ASSEMBLY TO URGE THEM TO OPPOSE FURTHER CUTS TO HEALTH CARE SERVICES FOR THE STATE'S LOWEST INCOME RESIDENTS. AT THE NATIONAL LEVEL, WE WORKED WITH OUR ELECTED REPRESENTATIVES TO PASS HEALTH CARE REFORM AND TO BEGIN THE PROCESS OF IMPLEMENTING THE PROVISIONS CONTAINED IN THE HISTORIC AFFORDABLE CARE ACT LEGISLATION. WE ALSO FORMED AN ADVOCACY TEAM THAT HAS BEEN MEETING MONTHLY AND CONDUCTED A VOTER REGISTRATION DRIVE PRIOR TO THE NOVEMBER 2010 ELECTIONS. 3033757 750000 372368 125680 4030445 3824957 10700 -657819 144081 3033757 1.00000 0 0 1363223 1363223 5991008 3331732 2659276 4418414 2717414 1701000 1955185 947213 1007972 6731471 ucla stip fund 755175 C ucla eip fund 3545056 C donated property 1394040 C 5694271 PLEDGE LIABILITIES 557646 LINE OF CREDIT 750000 1307646 35784962 32831472 2953490 63342 63342 3016832 39099928 63342 2900201 351423 3314966 35784962 0 35784962 36083096 2900201 351423 3251624 32831472 0 32831472 Part V, Line 4: Description of Intended Use of Endowment Funds: 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. Part X: Description of Uncertain Tax Positions Under FIN 48: 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, 2010, the Clinic did not recognize any amount in potential interest and penalties associated with uncertain tax positions. Part XII, Line 2d - Other Adjustments: SPECIAL EVENTS: 351423. Part XIII, Line 2d - Other Adjustments: SPECIAL EVENTS: 351423. X X X X X X 1 WILLIAM JONES VARIOUS 0 1861559 230802 1630757 1861559 230802 1630757 CA ART WALK 481291 310281 171010 17087 153923 SILVER CIRCLE 929346 796633 132713 92635 40078 2 220120 172420 47700 47700 1630757 1279334 351423 109722 241701 351423 0 0 0 0 0 VENICE FAMILY CLINIC

604 ROSE AVENUE VENICE CA 90291

X Part V: The Clinic serves as a family doctor, 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 80,290 primary health care visits, 8,550 specialty care visits, 2,296 dental visits and 8,188 mental health care visits, and 7,138 health education visits. Part VI, Line 2: The Venice family clinic conducts a community needs assessment every 3-5 years in conjunction with its strategic planning efforts. As part of this assessment, Venice family clinic looks at health data, demographic data, educational data and income data to determine the specific needs of the community Venice family clinic serves Part VI, Line 3: Venice family clinic provides education through its health insurance enrollment program about a patient's potential eligibility for public health insurance and other types of federal, state and local programs that our clients may be eligible for. Part VI, Line 4: The Clinic's 24,413 patients in 2010 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 Southern California. Part VI, Line 6: The Clinic serves as a family doctor, 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 80,290 primary health care visits, 8,550 specialty care visits, 2,296 dental visits and 8,188 mental health care visits, and 7,138 health education visits.The clinic is not considered to be a typical hospital, and therefore, many of the questions on schedule H that did not apply to the organization were not answered. X X 0 0 0 0 0 0 0 0 0 ELIZABETH B FORER 163882 0 0 0 0 0 0 0 28877 0 192759 0 0 0 LORETO S MELO 119507 0 0 0 5493 0 0 0 25153 0 150153 0 0 0 KAREN C LAMP 163698 0 0 0 0 0 0 0 29190 0 192888 0 0 0 SAKURA LING KUO 140382 0 0 0 0 0 0 0 23855 0 164237 0 0 0 MARGARITA LOEZA 128782 0 0 0 0 0 0 0 22765 0 151547 0 0 0 sharon ng 145549 0 0 0 0 0 0 0 27841 0 173390 0 0 0 NORMA ROSALES 138494 0 0 0 0 0 0 0 22658 0 161152 0 0 0 X 22 10915795 FAIR MARKET VALUE 0 1 0 Non Reporting of Revenue: Part I, Line 33: Clothing gets donated to us and we in turn give them to our homeless patients. 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 made available for the rest of the board 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 AND ON THE INTERNET AT www.guidestar.org. 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 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 University of California Los Angeles C 60000