2022-05-13T18:36:25-05:00 2021-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2020-07-01 941744108 LA CLINICA DE LA RAZA INC LACL 5105354000 PO BOX 22210 OAKLAND CA 946232210 SUSAN MOORE CFO 5105352924 2022-05-13 1 SUSAN MOORE 999009999 MICHAEL LUMSDEN P01262236 4159561500 2022-05-13 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z JANE GARCIA PO BOX 22210 OAKLAND CA 946232210 121956055 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 1315 334 0 0 42112569 45297672 72875408 75564847 534841 1091536 148796 2000 115671614 121956055 0 0 0 0 84626038 87875365 0 0 114332 29442540 31817279 114068578 119692644 1603036 2263411 94714871 148316145 32539949 84320206 62174922 63995939 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 94623791 0 75564847 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 79,536 PATIENTS DURING THE 6/30/2021 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. 94623791 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 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 1 254 0 1 1315 1 0 0 0 0 0 0 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 5105352915 1450 FRUITVALE AVENUE THIRD FLOOR OAKLAND CA 94601 JANE GARCIA CHIEF EXECUTIVE OFFICER 40.00 1.00 X 333222 0 68494 JORGE S SIOPACK MD PHYSICIAN & OB-GYN 40.00 0.00 X 332313 0 4352 JUAN E VARGAS MD LEAD OB-GYN 40.00 0.00 X 283169 0 18397 PAUL BAYARD MD MPH CHIEF MEDICAL OFFICER 40.00 0.00 X 250262 0 34340 LERIDA LIPUMANO-PICAZO DMD RESIDENCY CLINICAL DIRECTOR 40.00 0.00 X 243280 0 1874 LISA MONTANG MD PHYSICIAN ASSOCIATE MEDICAL DIRECTOR 40.00 0.00 X 209124 0 34222 JOHN MURPHY MD CHIEF MEDICAL INFORMATION OFFICER 40.00 0.00 X 224636 0 7938 SUSAN MOORE CHIEF FINANCIAL OFFICER 40.00 1.00 X 201557 0 25997 MICHELE HELMAN MD PHYSICIAN ASSOCIATE MEDICAL DIRECTOR 40.00 0.00 X 217166 0 5407 DOLLY DAVAR PHARMACY DIRECTOR 40.00 0.00 X 214217 0 2880 FERNANDO CORTEZ CHIEF INFORMATION OFFICER 40.00 0.00 X 164131 0 48336 ANITA ADDISON CHIEF OF PLANNING & STRAT ADVANCEMENT 40.00 0.00 X 172684 0 34957 FREDDIE L WOODARD DIRECTOR OF BILLING 40.00 0.00 X 156665 0 13170 JOHN MOUTOUSSAMY DIRECTOR OF HR THROUGH 4/2021 40.00 0.00 X 157761 0 2185 ARIANE TERLET DDS CHIEF DENTAL OFFICER 40.00 0.00 X 134985 0 23471 ZENAIDA AGUILERA COMPLIANCE & PRIVACY OFFICER 40.00 0.00 X 138291 0 13718 YVONNE HUDSON-HARMON PRES THROUGH 5/2021 / INT DIR OF HR 1.00 1.00 X X 0 0 0 RAMON TERRAZAS MD MPH VICE PRESIDENT / PRES START 5/2021 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 ROBERT CALVIN KATTER PARLIAMENTARIAN 1.00 1.00 X 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 BLANCA GOMEZ DIRECTOR START 9/2020 1.00 1.00 X 0 0 0 NORMA GUADALUPE GUERRERO DIRECTOR 1.00 1.00 X 0 0 0 AISHA HAMPTON-BOWSER DIRECTOR 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 CARMEN MARTINEZ DIRECTOR START 10/2020 1.00 1.00 X 0 0 0 DR TINA RAINE-BENNETT DIRECTOR 1.00 1.00 X 0 0 0 MARIA TSAKLANOS DIRECTOR THROUGH 9/2020 1.00 1.00 X 0 0 0 3433463 0 339738 136 0 1 0 SECURITY ENFORCEMENT ALLIANCE INC PO BOX 2279 NAPA CA 94558 SECURITY SERVICES 1296549 TOWNSHIP BUILDING SERVICES INC 26 PAMARON WAY SUITE A NOVATO CA 94949 MAINTENANCE SERVICES 1156961 NEXTGEN HEALTHCARE INC PO BOX 511449 LOS ANGELES CA 90051 SOFTWARE/IT SERVICES 965729 OCHIN INC 1881 SW NAITO PKWY PORTLAND OR 97201 SOFTWARE/IT SERVICES 778176 MED TECH SOLUTIONS INC PO BOX 748882 LOS ANGELES CA 90074 SOFTWARE/IT SERVICES 723344 46 38001298 7296374 852531 45297672 NET PATIENT REVENUE 621400 61873742 61873742 CAPITATION REVENUE 621400 8048528 8048528 PHARMACY - 340B PROG REV 621400 3528172 3528172 OTHER OPERATING REV 621400 2114405 2114405 75564847 772074 772074 2000 0 2000 2000 2000 319462 0 319462 319462 319462 121956055 75564847 0 1093536 2269817 197136 2072681 60292846 52302783 7949017 41046 2216903 1645541 570206 1156 18092998 15296607 2785747 10644 5002801 4205898 793614 3289 773305 400164 363796 9345 135869 4000 131869 155273 155273 7804029 6810769 984904 8356 9134 9132 2 9492857 8402980 1066376 23501 5071920 159114 4911040 1766 4070957 3033386 1037320 251 90702 34414 56288 1482 424 1058 192997 186031 6966 2583180 1525880 1057032 268 441438 63683 377755 OTHER TAXES & FEES 480692 168988 300330 11374 COURIER & DELIVERY 293322 124725 168597 0 ORGANIZATIONAL DUES 168039 13327 151376 3336 52083 38809 13274 119692644 94623791 24954521 114332 10719030 20688023 4489591 4808511 3439274 8076267 7757642 9371222 12038400 12038400 386127 338520 1055941 804484 61461752 27887383 33768594 33574369 16863821 17476604 3637770 6523583 558681 34616162 94714871 148316145 11658638 14351575 4596339 5139729 6494727 6185250 6831927 6380859 10000000 2958318 42262793 32539949 84320206 X 53307564 61154552 8867358 2841387 62174922 63995939 94714871 148316145 2263411 -442394 0 X 0 1 X 1 1 1 X 29427380 40433770 33465986 42112569 45297672 190737377 29427380 40433770 33465986 42112569 45297672 190737377 1272302 189465075 414080 442077 680579 503910 774074 2814720 129958 1211 154105 145796 0 431070 402916 402916 194386083 376534626 0.97470 0.96480 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2016 AMOUNT: $ 402,916. 2017 AMOUNT: $ 0. 2018 AMOUNT: $ 0. 2019 AMOUNT: $ 0. 2020 AMOUNT: $ 0. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7500 7500 0 PART II-B, LINE 1: THE ORGANIZATION PAYS MEMBERSHIP DUES TO THE CALIFORNIA PRIMARY CARE ASSOCIATION; A PORTION OF THOSE DUES HAVE BEEN INDICATED AS UTILIZED FOR LOBBYING ACTIVITIES PERTINENT TO THE HEALTH CARE INDUSTRY. 2085517 2085517 34112627 17156328 16956299 7345189 510048 6835141 17851313 10221007 7630306 67106 67106 33574369 PAYROLL CLEARING 11119 DEPOSITS 802518 INTEREST RECEIVABLE 5718 OPERATING LEASE RIGHT OF USE ASSETS 33796807 34616162 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 8195750 ACCRUED DENTAL LITIGATION 162964 OPERATING LEASE LIABILITIES 33559079 DUE TO LA CLINICA GEORGIA STREET 345000 42262793 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, 2021 AND 2020, 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. X X 0 1 0 0 0 0 0 0 0 JANE GARCIA CHIEF EXECUTIVE OFFICER 333222 0 0 0 0 0 43617 0 24877 0 401716 0 0 0 JORGE S SIOPACK MD PHYSICIAN & OB-GYN 332313 0 0 0 0 0 3617 0 735 0 336665 0 0 0 JUAN E VARGAS MD LEAD OB-GYN 283169 0 0 0 0 0 2292 0 16105 0 301566 0 0 0 PAUL BAYARD MD MPH CHIEF MEDICAL OFFICER 250262 0 0 0 0 0 3617 0 30723 0 284602 0 0 0 LERIDA LIPUMANO-PICAZO DMD RESIDENCY CLINICAL DIRECTOR 243280 0 0 0 0 0 1874 0 0 0 245154 0 0 0 LISA MONTANG MD PHYSICIAN ASSOCIATE MEDICAL DIRECTOR 209124 0 0 0 0 0 3499 0 30723 0 243346 0 0 0 JOHN MURPHY MD CHIEF MEDICAL INFORMATION OFFICER 224636 0 0 0 0 0 2777 0 5161 0 232574 0 0 0 SUSAN MOORE CHIEF FINANCIAL OFFICER 201557 0 0 0 0 0 2023 0 23974 0 227554 0 0 0 MICHELE HELMAN MD PHYSICIAN ASSOCIATE MEDICAL DIRECTOR 217166 0 0 0 0 0 2343 0 3064 0 222573 0 0 0 DOLLY DAVAR PHARMACY DIRECTOR 214217 0 0 0 0 0 2499 0 381 0 217097 0 0 0 FERNANDO CORTEZ CHIEF INFORMATION OFFICER 164131 0 0 0 0 0 3605 0 44731 0 212467 0 0 0 ANITA ADDISON CHIEF OF PLANNING & STRAT ADVANCEMEN 172684 0 0 0 0 0 3592 0 31365 0 207641 0 0 0 FREDDIE L WOODARD DIRECTOR OF BILLING 156665 0 0 0 0 0 2368 0 10802 0 169835 0 0 0 JOHN MOUTOUSSAMY DIRECTOR OF HR THROUGH 4/2021 157761 0 0 0 0 0 2023 0 162 0 159946 0 0 0 ARIANE TERLET DDS CHIEF DENTAL OFFICER 134985 0 0 0 0 0 21779 0 1692 0 158456 0 0 0 ZENAIDA AGUILERA COMPLIANCE & PRIVACY OFFICER 138291 0 0 0 0 0 2777 0 10941 0 152009 0 0 0 PART I, LINE 4B JANE C. GARCIA PARTICIPATES IN A SUPPLEMENTAL, NONQUALIFIED 457(F) RETIREMENT PLAN. DURING THE 2020 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 NONEAVAIL 2019-09-06 4103362 REFUND OF TAXABLE BONDS ISSUED 3/20/2019 0 0 0 A 1575000 3855000 3855000 2011 0 0 1 1 B 114477 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 0 1 0 1 0 0 0 1 A 1 B 1 X 29 852531 FAIR MARKET VALUE 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 1 1 0 1 1 0 0 0 0 LA CLINICA VALLEJO GEORGIA STREET PROPERTY OWNER B 2962452 BOOK / ACTUAL VALUE LA CLINICA VALLEJO GEORGIA STREET PROPERTY OWNER K 345000 BOOK / ACTUAL VALUE