2021-05-13T22:48:19-05:00 2020-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2019-07-01 941744108 LA CLINICA DE LA RAZA INC LACL 5105354000 PO BOX 22210 OAKLAND CA 946232210 SUSAN MOORE CFO 5105352924 2021-05-13 1 MICHAEL LUMSDEN P01262236 4159561500 2021-05-13 2019 2022-09-23 18:48:47Z JANE GARCIA PO BOX 22210 OAKLAND CA 946232210 116042050 0 X WWW.LACLINICA.ORG X 1971 CA COMPREHENSIVE MEDICAL SERVICES TO INDIVIDUALS IN NEED, REGARDLESS OF RACE, AGE OR ABILITY TO PAY. 14 14 1316 201 0 0 33465986 42112569 82658262 72875408 662579 534841 172105 148796 116958932 115671614 0 0 0 0 82362435 84626038 0 0 198651 28261682 29442540 110624117 114068578 6334815 1603036 91387277 94714871 31302568 32539949 60084709 62174922 X TO IMPROVE THE QUALITY OF LIFE OF THE DIVERSE COMMUNITIES WE SERVE BY PROVIDING CULTURALLY APPROPRIATE, HIGH QUALITY, AND ACCESSIBLE HEALTH CARE FOR ALL. 0 0 89764890 0 72875408 LOCATED IN OAKLAND, SAN LEANDRO, AND SAN LORENZO IN ALAMEDA COUNTY; PITTSBURG, OAKLEY, AND CONCORD IN CONTRA COSTA COUNTY; AND VALLEJO IN SOLANO COUNTY, LA CLINICA SERVED 72,580 PATIENTS DURING THE 6/30/2020 FISCAL YEAR. LA CLINICA OPERATES AT MORE THAN THREE DOZEN LOCATIONS, INCLUDING THE FOLLOWING CLINICS: MEDICAL, DENTAL, AND BEHAVIORAL HEALTH CLINICS AT LA CLINICA DE LA RAZA (AT THE FRUITVALE TRANSIT VILLAGE), WHICH INCLUDES PHARMACY, LABORATORY, AND RADIOLOGY; LA CLINICA DE LA RAZA DENTAL (ON FRUITVALE AVENUE); CASA DEL SOL (MENTAL HEALTH CLINIC) I, II, AND III; CLINICA ALTA VISTA (A TEEN CLINIC); SAN ANTONIO NEIGHBORHOOD HEALTH CENTER, WHICH INCLUDES PHARMACY; FAMILY OPTICAL (EYE CLINIC); TWO WOMEN INFANTS AND CHILDREN ("WIC") PROGRAMS, ONE IN THE SAN ANTONIO NEIGHBORHOOD HEALTH CENTER AND ONE AT A FREE-STANDING SITE; A DENTAL CLINIC NEAR CHILDREN'S HOSPITAL OAKLAND; DAVIS PEDIATRICS, A PEDIATRIC PRACTICE ON FOOTHILL BOULEVARD; A MEDICAL CLINIC IN PITTSBURG; A DENTAL CLINIC IN PITTSBURG; A MOBILE DENTAL CLINIC SERVING CONTRA COSTA COUNTY; A MEDICAL, DENTAL, AND OPTICAL CLINIC IN CONCORD; A MEDICAL CLINIC IN OAKLEY; THREE MEDICAL CLINICS IN VALLEJO; AND A DENTAL CLINIC IN VALLEJO. THE ORGANIZATION ALSO RUNS EIGHT SCHOOL-BASED MEDICAL CLINICS: HAWTHORNE ELEMENTARY SCHOOL-BASED CLINIC, ROOSEVELT HEALTH CENTER, TIGER HEALTH CLINIC (AT FREMONT HIGH), SAN LORENZO HIGH HEALTH CENTER, TECHNICLINIC (AT OAKLAND TECHNICAL HIGH), HAVENSCOURT HEALTH CENTER, YOUTH HEART HEALTH CENTER (AT DOWNTOWN EDUCATIONAL COMPLEX), AND FUENTE WELLNESS CENTER (AT REACH ASHLAND YOUTH CENTER), THREE SCHOOL-BASED DENTAL CLINICS, AND PROVIDES PERIODIC DENTAL SCREENINGS AND TREATMENTS TO ABOUT FIFTEEN SCHOOLS IN ALAMEDA AND CONTRA COSTA COUNTIES. 89764890 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 252 0 1 1316 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X SUSAN MOORE 5105352924 1450 FRUITVALE AVENUE THIRD FLOOR OAKLAND CA 94601 JANE GARCIA CHIEF EXECUTIVE OFFICER 40.00 1.00 X 313010 0 48746 JORGE S SIOPACK MD PHYSICIAN - OB 40.00 0.00 X 336621 0 2950 JUAN E VARGAS MD PHYSICIAN - OB-GYN 40.00 0.00 X 273301 0 21335 PAUL BAYARD MD MPH CHIEF MEDICAL OFFICER 40.00 0.00 X 225268 0 33904 LISA MONTANG MD PHYSICIAN, ASSOC. MEDICAL DIRECTOR 40.00 0.00 X 211721 0 35464 JOHN MURPHY MD MEDICAL INFORMATION OFFICER 40.00 0.00 X 226132 0 2434 CHARLES SOM DO CONTRA COSTA REG. MED. DIRECTOR 40.00 0.00 X 190429 0 35035 SUSAN SYKES MD OB-GYN, ASSOCIATE MEDICAL DIRECTOR 40.00 0.00 X 189314 0 31484 SUSAN MOORE CHIEF FINANCIAL OFFICER 40.00 1.00 X 188438 0 25420 FERNANDO CORTEZ CHIEF INFO & INFO SECURITY OFFICER 40.00 0.00 X 159001 0 47751 YVONNE HUDSON-HARMON PRESIDENT 1.00 1.00 X X 0 0 0 RAMON TERRAZAS MD MPH VICE PRESIDENT 1.00 1.00 X X 0 0 0 CHRISTOPHER OHMAN SECRETARY 1.00 1.00 X X 0 0 0 PAUL MARRIOTT SWENSON MBA TREASURER 1.00 1.00 X X 0 0 0 NORMA GUADALUPE GUERRERO PARLIAMENTARIAN THROUGH 8/2019/DIR. 1.00 1.00 X X 0 0 0 ROBERT CALVIN KATTER PARLIAMENTARIAN START 8/2019 1.00 1.00 X X 0 0 0 DANIEL AYALA DIRECTOR THROUGH 12/2019 1.00 1.00 X 0 0 0 SOPHIA BUCHELI DIRECTOR 1.00 1.00 X 0 0 0 ELIZABETH DIAZ DIRECTOR 1.00 1.00 X 0 0 0 MARIA DE LOS ANGELES ESPINOZA DIRECTOR 1.00 1.00 X 0 0 0 AISHA HAMPTON-BOWSER DIRECTOR 1.00 1.00 X 0 0 0 RACHEL HARRALSON DIRECTOR THROUGH 12/2019 1.00 1.00 X 0 0 0 TERRELL JACKSON DIRECTOR 1.00 1.00 X 0 0 0 REVEREND RODNEY J LEGGETT DIRECTOR 1.00 1.00 X 0 0 0 DR TINA RAINE-BENNETT DIRECTOR 1.00 1.00 X 0 0 0 MARIA TSAKLANOS DIRECTOR 1.00 1.00 X 0 0 0 2313235 0 284523 136 0 1 0 SECURITY ENFORCEMENT ALLIANCE INC PO BOX 2279 NAPA CA 94558 SECURITY SERVICES 1447013 TOWNSHIP BUILDING SERVICES INC 26 PAMARON WAY SUITE A NOVATO CA 94949 MAINTENANCE SERVICES 1278798 NEXTGEN HEALTHCARE INC PO BOX 511449 LOS ANGELES CA 90051 SOFTWARE/IT SERVICES 863962 MED TECH SOLUTIONS INC PO BOX 748882 LOS ANGELES CA 90074 SOFTWARE/IT SERVICES 657870 BROWN & TOLAND HEALTH PO BOX 70330 OAKLAND CA 94612 CONTRACTED MEDICAL SERVICES 389692 21 74994 27852061 14185514 1149519 42112569 NET PATIENT REVENUE 621400 60599749 60599749 CAPITATION REVENUE 621400 7029603 7029603 PHARMACY - 340B PROG REV 621400 3990631 3990631 OTHER OPERATING REV 621400 1255425 1255425 72875408 500910 500910 3000 0 3000 3000 3000 253475 219544 33931 33931 33931 287748 74994 147812 139936 139936 8940 3080 5860 5860 115671614 72875408 0 683637 1273336 24267 1249069 59767829 50534026 9137361 96442 1812130 1529478 280036 2616 17134831 14126297 2981633 26901 4637912 3848471 782127 7314 468541 167679 291656 9206 242832 5881 236951 108550 108550 8897709 6381999 2514075 1635 20838 10681 10157 9016319 7846020 1134662 35637 3276258 19720 3255653 885 3816252 3039914 776119 219 178081 117380 60047 654 13010 11970 1040 273283 267271 6012 1860214 1436001 424191 22 359758 20984 338774 OTHER TAXES & FEES 385334 179460 190453 15421 COURIER & DELIVERY 283607 96411 187115 81 ORGANIZATIONAL DUES 122682 15182 106009 1491 119272 85798 33347 127 114068578 89764890 24105037 198651 7025321 10382108 4553136 4826513 6528202 3439274 10958984 7757642 12038400 12038400 208556 386127 2021918 1055941 59072797 25304203 29628913 33768594 15613315 16863821 2064065 3637770 746467 558681 91387277 94714871 10596139 11658638 2975094 4596339 2665000 6494727 11313790 6831927 3752545 2958318 31302568 32539949 X 51969976 53307564 8114733 8867358 60084709 62174922 91387277 94714871 1603036 487177 0 X 0 1 X 1 1 1 X 28382966 29427380 40433770 33465986 42112569 173822671 28382966 29427380 40433770 33465986 42112569 173822671 2599213 171223458 347027 414080 442077 680579 503910 2387673 129958 1211 154105 145796 431070 423742 402916 826658 177468072 369350640 0.96480 0.96290 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2015 AMOUNT: $ 423,742. 2016 AMOUNT: $ 402,916. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2085517 2085517 34011269 14105263 19906006 7320060 2294693 5025367 15153591 8904247 6249344 502360 502360 33768594 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 2618219 ACCRUED DENTAL LITIGATION 340099 2958318 X PART X, LINE 2: THE ORGANIZATION IS A NONPROFIT CORPORATION UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND HAS BEEN GRANTED TAX-EXEMPT STATUS BY THE INTERNAL REVENUE SERVICE AND THE CALIFORNIA REVENUE AND TAXATION CODE. AS OF JUNE 30, 2020 AND 2019, THE ORGANIZATION HAD NO UNRECOGNIZED TAX POSITIONS OR UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED IN THE FINANCIAL STATEMENTS. ALL THAT JAZZ (& SUSHI) 362742 74994 287748 74994 27308 45510 362742 74994 287748 74994 27308 45510 147812 139936 1 X X 0 1 0 0 0 0 0 0 0 JANE GARCIA CHIEF EXECUTIVE OFFICER 313010 0 0 0 0 0 23805 0 24941 0 361756 0 0 0 JORGE S SIOPACK MD PHYSICIAN - OB 336621 0 0 0 0 0 2815 0 135 0 339571 0 0 0 JUAN E VARGAS MD PHYSICIAN - OB-GYN 273301 0 0 0 0 0 1768 0 19567 0 294636 0 0 0 PAUL BAYARD MD MPH CHIEF MEDICAL OFFICER 225268 0 0 0 0 0 3305 0 30599 0 259172 0 0 0 LISA MONTANG MD PHYSICIAN, ASSOC. MEDICAL DIRECTOR 211721 0 0 0 0 0 3305 0 32159 0 247185 0 0 0 JOHN MURPHY MD MEDICAL INFORMATION OFFICER 226132 0 0 0 0 0 2434 0 0 0 228566 0 0 0 CHARLES SOM DO CONTRA COSTA REG. MED. DIRECTOR 190429 0 0 0 0 0 2160 0 32875 0 225464 0 0 0 SUSAN SYKES MD OB-GYN, ASSOCIATE MEDICAL DIRECTOR 189314 0 0 0 0 0 2204 0 29280 0 220798 0 0 0 SUSAN MOORE CHIEF FINANCIAL OFFICER 188438 0 0 0 0 0 1836 0 23584 0 213858 0 0 0 FERNANDO CORTEZ CHIEF INFO & INFO SECURITY OFFICER 159001 0 0 0 0 0 3182 0 44569 0 206752 0 0 0 PART I, LINE 4B JANE C. GARCIA PARTICIPATES IN A SUPPLEMENTAL, NONQUALIFIED 457(F) RETIREMENT PLAN. DURING THE 2019 CALENDAR YEAR, CONTRIBUTIONS TO THE PLAN TOTALED $20,500, WHICH HAS BEEN REPORTED AS "DEFERRED COMPENSATION" ON SCHEDULE J, PART II, COLUMN (C); THERE WERE NO DISTRIBUTIONS OR AMOUNTS TREATED AS TAXABLE COMPENSATION DUE TO SUBSTANTIAL RISK OF FORFEITURE FROM THE PLAN. A ABAG FINANCE AUTHORITY FOR NONPROFIT CORPORATIONS 943130123 00037CQV5 2010-12-30 3855000 FINANCING OF MONUMENT HEALTH CLINIC IN CONCORD, CA 0 0 0 B CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 000000000 2019-09-06 4103362 REFUND OF TAXABLE BONDS ISSUED 3/20/2019 0 0 0 A 1380000 3855000 3855000 2011 0 0 1 1 B 4103362 82000 4021362 0 1 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 1 0 0 1 0 0 0 1 A 1 B 1 X 33 1149519 SELLING PRICE 0 0 1 0 PART I, COLUMN (B): THE ORGANIZATION IS REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED IN SCHEDULE M, PART I, COLUMN (B). FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT TAX PREPARER IN CONJUNCTION WITH THE ORGANIZATION'S FINANCE AND ACCOUNTING DEPARTMENT. UPON REVIEW AND APPROVAL BY THE FINANCE AND ACCOUNTING DEPARTMENT, THE FORM 990 IS THEN REVIEWED BY THE AUDIT COMMITTEE OF THE BOARD AND THEN SENT ELECTRONICALLY TO ALL MEMBERS OF THE BOARD PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY WHICH COVERS DIRECTORS, OFFICERS, AND EMPLOYEES WHO CAN INFLUENCE THE ACTIONS OF LA CLINICA; ALL SUCH INDIVIDUALS ARE REQUIRED TO COMPLETE A "CONFLICT OF INTEREST QUESTIONNAIRE & DISCLOSURE STATEMENT" ANNUALLY. IN THE EVENT A CONFLICT OF INTEREST IS IDENTIFIED, DISCLOSURE SHOULD BE MADE TO THE COMPLIANCE OFFICER (OR IF SHE OR HE IS THE ONE WITH THE CONFLICT, THEN TO THE BOARD CHAIR), WHO SHALL BRING THE MATTER TO THE ATTENTION OF THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD. TRANSACTIONS WITH PARTIES WITH WHOM CONFLICTING INTEREST EXISTS MAY BE UNDERTAKEN ONLY IF ALL THE FOLLOWING ARE OBSERVED: (I) THE CONFLICTING INTEREST IS FULLY DISCLOSED; (II) THE PERSON WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTION; (III) A COMPETITIVE BID OR COMPARABLE CALCULATION EXISTS, AND IS ACCORDANCE WITH LA CLINICA'S PROCUREMENT POLICY; AND (IV) THE BOARD OR A DULY CONSTITUTED COMMITTEE THEREOF, HAS DETERMINED THAT THE TRANSACTION IS IN THE BEST INTEREST OF THE ORGANIZATION. THE DECISION OF THE BOARD OR COMMITTEE IS DOCUMENTED WITHIN THE BOARD/COMMITTEE MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 THE SALARY FOR THE CEO IS DETERMINED BY THE MEMBERS OF THE BOARD OF DIRECTORS, WHICH CONSISTS ENTIRELY OF INDEPENDENT PERSONS. SALARIES FOR OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION IS DETERMINED BY THE CEO. BOTH THE BOARD OF DIRECTORS AND THE CEO UTILIZE COMPARABILITY DATA WHEN MAKING COMPENSATION DECISIONS, AND ALSO TAKE INTO ACCOUNT THE SIZE AND COMPLEXITY OF THE COMPARABLE ORGANIZATIONS, THE EMPLOYEE'S TENURE, AND OTHER SUCH INFORMATION. FORM 990, PART VI, SECTION C, LINE 19 THE AUDITED FINANCIAL STATEMENTS ARE DISTRIBUTED UPON REQUEST. THE GOVERNING/ORGANIZING DOCUMENTS ARE AVAILABLE ON THE WEBSITE AT WWW.LACLINICA.ORG. THE CONFLICT OF INTEREST POLICY IS AVAILABLE ON REQUEST. LA CLINICA VALLEJO GEORGIA STREET PROPERTY OWNER PO BOX 22210 OAKLAND CA 946232210 831342199 NMTC FINANCING FOR NEW HEALTH CARE FACILITY IN VALLEJO, CA CA 501(C)(3) LINE 12A, I LA CLINICA DE LA RAZA INC 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 LA CLINICA VALLEJO GEORGIA STREET PROPERTY OWNER B 1573705 BOOK/ACTUAL VALUE