2011-11-15T13:58:53-06:00 2011-06-30 BURR PILGER MAYER INC 600 CALIFORNIA STREET SUITE 1300 SAN FRANCISCO CA 94108 990 2010-07-01 262593712 VOLUNTEERS IN MEDICINE - SAN FRANCISCO DBA CLINIC BY THE BAY VOLU 4154050222 4877 MISSION STREET SAN FRANCISCO CA 94112 JANET REILLY 4154050222 2011-11-11 1 DEBORAH KAMINSKI 4154215757 2010 2016-02-24 21:20:13Z JANET REILLY 4877 MISSION STREET SAN FRANCISCO CA 94112 479259 0 X WWW.CLINICBYTHEBAY.ORG X 2008 CA TO ENGAGE VOLUNTEERS TO PROVIDE QUALITY HEALTH CARE IN A FREE CLINIC FOR THE WORKING UNINSURED. 11 11 7 85 0 0 342806 467615 0 0 304 40 976 11604 344086 479259 0 0 0 0 122032 306974 55264 0 28457 76512 134929 253808 441903 90278 37356 138922 184238 4524 12467 134398 171771 TO UNDERSTAND AND SERVE, WITH DIGNITY AND RESPECT THE HEALTH AND WELLNESS NEEDS OF THE MEDICALLY UNDERSERVED IN THE SAN FRANCISCO BAY AREA. 0 0 218247 FREE PRIMARY AND PREVENTIVE HEALTH CARE SERVICES FOR LOW-INCOME WORKING UNINSURED ADULTS. SERVICES INCLUDE: PRIMARY CARE CLINIC VISITS; COORDINATED REFERRALS FOR SPECIALTY, DIAGNOSTIC AND SURGICAL CARE; INDIVIDUAL AND GROUP HEALTH EDUCATION; COMMUNITY OUTREACH; AND PSYCHOSOCIAL ASSESSMENT AND REFERRALS. 172527 VOLUNTEER PROGRAM: CREATE AND SUPPORT MEANINGFUL, PROFESSIONAL OPPORTUNITIES FOR CIVIC ENGAGEMENT. RECRUITMENT, ORIENTATION, TRAINING AND ON-GOING RETENTION OF HEALTH CARE PROFESSIONALS (MD, NP, RN) AND COMMUNITY MEMBERS TO PROVIDE FREE HEALTH CARE AND HEALTH EDUCATION TO LOW-INCOME UNINSURED ADULTS. 1651 1651 392425 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 6 0 7 1 0 0 0 0 0 1 1 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 CA X ELIZA GIBSON EXEC DIRECTOR 4154050222 4877 MISSION STREET SAN FRANCISCO CA 94112 JANET REILLY 8.00 X X 0 0 0 SCOTT HAUGE 8.00 X X 0 0 0 CHERYL BARTH 2.00 X X 0 0 0 PETRA CHAVEZ 2.00 X 0 0 0 RITA SEMEL 2.00 X 0 0 0 PAUL TUREK MD 2.00 X 0 0 0 LYNN JIMENEZ 2.00 X 0 0 0 SETH SCHOLAR 2.00 X 0 0 0 CHARLIE WILSON 2.00 X 0 0 0 KAREN KAUFMAN 2.00 X 0 0 0 JOHN LEGNITTO 2.00 X 0 0 0 ELIZA GIBSON 40.00 X 90000 0 0 90000 0 0 0 0 0 0 0 67450 400165 467615 40 40 11280 67450 0 11280 11280 OTHER INCOME 900099 324 324 324 479259 0 0 11644 89723 79853 2692 7178 164571 149444 3168 11959 52680 47410 1055 4215 2956 2956 14366 13611 755 8626 8626 4133 3711 211 211 3646 2191 1286 169 54188 48770 2709 2709 816 816 717 426 291 9 9 9072 8164 454 454 9508 6194 3314 EQUIPMENT 10766 9740 513 513 ADMIN & OTHER SUPPLIES 4319 3887 216 216 VOLUNTEER EXPENSES 4112 4112 MEDICAL SUPPLIES 2741 2741 MISCELLANEOUS 1394 1254 70 70 3560 1475 1322 763 441903 392425 21021 28457 106161 139345 6933 10500 38981 12150 19091 26831 6737 7562 138922 184238 4524 12467 4524 12467 X 126006 124271 8392 47500 134398 171771 138922 184238 X 37356 17 X 0 0 0 X 190825 342806 691672 1225303 190825 342806 691672 1225303 300001 925302 3 304 40 347 976 324 1300 1226950 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 22170 10469 11701 16811 1681 15130 26831 OTHER CURRENT LIABILITIES 2580 ACCRUED VACATION 9887 12467 479259 441903 37356 17 17 37373 692036 212777 212777 479259 0 479259 654680 212777 212777 441903 0 441903 PART XII, LINE 2D - OTHER ADJUSTMENTS: IN-KIND INCOME 212,777. PART XIII, LINE 2D - OTHER ADJUSTMENTS: IN-KIND EXPENSES 212,777. SCOMA'S 8800 7920 880 BELIEVE IT 69930 59530 10400 78730 67450 11280 11280 1 PRIMARY CARE MEDICAL SERVICES FOR UNINSURED ADULTS 275 116878 FMV PRIMARY CARE OFFICE VISITS, DIAGNOSTIC AND ANCILLARY SERVICES (RADIOLOGY & LAB). FMV BASED UPON MEDICARE LEVEL 4 & 5 RATES + COSTS OF LAB & RADIOLOGY SERVICES PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: ELIGIBILITY CRITERIA FOR PRIMARY CARE MEDICAL SERVICES: CLINIC BY THE BAY PATIENTS MUST BE 18 YEARS OR OLDER, LIVE IN ONE OF OUR NEARBY ZIP CODES (94112, 94134, 94014, 94015), HAVE NO INSURANCE, AND HAVE INCOME AT OR BELOW 250% OF THE FEDERAL POVERTY LEVEL. X 3 56338 FMV AT TRANSFER DATE X 7 16454 FMV X 4 LAPTOPS, 1 PC, 1 SCANNER, DONOR WALL 2 7193 FMV 0 0 1 0 NON REPORTING OF REVENUE: PART I, LINE 33: DONATION OF SERVICES WERE NOT INCLUDED IN REVENUES. VOLUNTEERS IN MEDICINE - SAN FRANCISCO IS COMMITTED TO CREATING MEANINGFUL OPPORTUNITIES FOR CIVIC ENGAGEMENT AND AS SUCH, DONATED PROFESSIONALS SERVICES AND GOODS ARE CORE TO OUR OPERATIONS. DURING FISCAL YEAR 2010 - 2011, VOLUNTEER PHYSICIANS, NURSES, NURSE PRACTITIONERS, RECEPTIONISTS, INTERPRETERS AND OTHER DEDICATED COMMUNITY MEMBERS DONATED 3,852 HOURS IN SERVICES TO PROVIDE FREE HEALTH CARE TO LOW-INCOME WORKING UNINSURED ADULTS. THESE HOURS ARE VALUED AT $139,279. ADDITIONALLY, NEEDED ANCILLARY SERVICES (LAB AND RADIOLOGY) WERE DONATED, VALUED AT $23,212, AS WELL AS MEDICAL SUPPLIES ($5,825), MEDICATIONS ($5,243), AND MEDICAL EQUIPMENT ($5,388). THE OTHER LARGEST AREA OF DONATED SERVICES FOR THE ORGANIZATION IS IN THE AREA OF COMMUNITY OUTREACH AND PUBLIC RELATIONS, INCLUDING DONATED VIDEO PRODUCTION AND DONOR WALL DESIGN AND PRODUCTION ($14,852). ADDITIONAL MISCELLANEOUS GOODS AND SERVICES DONATED ARE VALUED AT $18,975 RESULTING IN A CUMULATIVE TOTAL OF $212,777 OF SERVICES DONATED TO VOLUNTEERS IN MEDICINE - SAN FRANCISCO DURING FISCAL YEAR 2010-2011. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION ENGAGED A PROFESSIONAL CPA FIRM TO PREPARE THE FORM 990, WHICH IS CLOSELY REVIEWED BY THE EXECUTIVE DIRECTOR. AN ELECTRONIC VERSION IS SUBMITTED TO ALL BOARD MEMBERS FOR COMMENT BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE GOVERNING BOARD ARE REQUIRED TO REFRAIN FROM ENGAGING IN TRANSACTIONS THAT PRESENT A CONFLICT TO THE ORGANIZATION, AND MUST (AT LEAST ANNUALLY), PROVIDE A WRITTEN STATEMENT TO THE BOARD THAT NO SUCH CONFLICTS EXIST. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE COMMITTEE, ON AN ANNUAL BASIS, REVIEWS AND SETS THE EXECUTIVE DIRECTOR'S SALARY. THE COMMITTEE CONSIDERS COMPARABLE SALARIES IN SIMILAR ORGANIZATIONS AS WELL AS THE PERFORMANCE OF THE DIRECTOR. FORM 990, PART VI, SECTION C, LINE 19 TAX RETURNS, CREATION AND GOVERNING DOCUMENTS ARE AVAILALBE UPON WRITTEN REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: PRIOR PERIOD ADJUSTMENTS: 17.