2023-05-01T10:35:05-05:00 2022-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2021-07-01 952977147 CLINICAS DEL CAMINO REAL INC CLIN 8056591740 PO BOX 4566 VENTURA CA 93007 FRED BENHARASH CFO 8056591740 2023-04-28 1 FRED BENHARASH 999009999 TERRI REXRODE CPA MST P00096513 9206620016 2023-04-24 0 AAL1 IAL1 2021 2023-04-26 12:10:37Z FRED BENHARASH PO BOX 4566 VENTURA CA 93007 112476288 0 X WWW.CLINICAS.ORG X 1971 CA IT IS THE EXPLICIT MISSION OF CLINICAS DEL CAMINO REAL TO SAVE LIVES AND RESTORE GOOD HEALTH BY PROVIDING QUALITY COMPREHENSIVE AND PREVENTATIVE PERSONAL AND HUMANE HEALTH CARE SERVICES TO THE MEDICALLY UNDERSERVED POPULATION OF VENTURA COUNTY. THIS MISSION IS ACCOMPLISHED BY ELIMINATING THE BARRIERS OF LIMITED INCOME, RESOURCES, CULTURAL, AND LANGUAGE THROUGH THE USE OF OUTREACH PROGRAMS, BILINGUAL AND BICULTURAL STAFF MEMBERS, AND A SLIDING FEE PROGRAM BASED ON A PATIENT'S ABILITY TO PAY. 8 8 1045 10 0 0 29985344 24065683 95060281 87545032 678314 568550 16352195 297023 142076134 112476288 0 0 0 0 69172505 68660362 0 0 0 74361449 54193734 143533954 122854096 -1457820 -10377808 207265824 172085216 111979707 114537911 95286117 57547305 X IT IS THE EXPLICIT MISSION OF CLINIAS DEL CAMINO REAL TO SAVE LIVES AND RESTORE GOOD HEALTH BY PROVIDING QUALITY COMPREHENSIVE AND PREVENTATIVE PERSONAL AND HUMANE HEALTH CARE SERVICES TO THE MEDICALLY UNDERSERVED POPULATION OF VENTURA COUNTY. THIS MISSION IS ACCOMPLISHED BY ELIMINATING THE BARRIERS OF LIMITED INCOME, RESOURCES, CULTURAL, AND LANGUAGE THROUGH THE USE OF OUTREACH PROGRAMS, BILINGUAL AND BICULTURAL STAFF MEMBERS, AND A SLIDING FEE PROGRAM BASED ON A PATIENT'S ABILITY TO PAY. 0 0 94280693 0 87545032 IT IS THE EXPLICIT MISSION OF CLINICAS DEL CAMINO REAL TO SAVE LIVES AND RESTORE GOOD HEALTH BY PROVIDING QUALITY COMPREHENSIVE AND PREVENTATIVE PERSONAL AND HUMANE HEALTH CARE SERVICES TO THE MEDICALLY UNDERSERVED POPULATION OF VENTURA COUNTY. THIS MISSION IS ACCOMPLISHED BY ELIMINATING THE BARRIERS OF LIMITED INCOME, RESOURCES, CULTURAL, AND LANGUAGE THROUGH THE USE OF OUTREACH PROGRAMS, BILINGUAL AND BICULTURAL STAFF MEMBERS, AND A SLIDING FEE PROGRAM BASED ON A PATIENT'S ABILITY TO PAY. TOTAL PATIENT ENCOUNTERS FOR THE YEAR WERE 300,974. 94280693 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 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 0 0 0 0 0 1 1 1 0 0 1 454 0 1045 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 CA X FRED BENHARASH 8056591740 1040 FLYNN RD CAMARILLO CA 93012 CHARLES HOOKSTRA PRESIDENT 1.00 X X 0 0 0 DR ADOLFO MURILLO VICE PRESIDENT 1.00 X X 0 0 0 KRISTIN CADY VICE PRESIDENT 1.00 X X 0 0 0 BARBARA A JOURNET TREASURER 1.00 X X 0 0 0 JAVIER M OCHOA PARLIAMENTARIAN 1.00 X X 0 0 0 ANGEL ARREOLA BOARD MEMBER 1.00 X 0 0 0 DR NANCY CARROLL BOARD MEMBER (THRU MAY 2022) 1.00 X 0 0 0 CANDELARIA FRANCO BOARD MEMBER 1.00 X 0 0 0 EDER GAONA-MACEDO BOARD MEMBER (THRU APRIL 2022) 1.00 X 0 0 0 DANIEL GONZALEZ BOARD MEMBER 1.00 X 0 0 0 GAGAN PAWAR CEO 40.00 X 436442 0 32334 CHRISTINA M VELASCO CFO (THRU SEPTEMBER 2021) 40.00 X 502413 0 18810 FRED BENHARASH CFO (BEGIN MARCH 2022) 40.00 X 0 0 0 ANTONIO ALATORRE CBDO 40.00 X 369529 0 18765 ANWAR ALI ABBAS CIO 40.00 X 218551 0 14512 KELLY LYNN BENNETT HR DIRECTOR 40.00 X 261756 0 24471 ANNA BELL MONROY COO 40.00 X 186179 0 8848 MENASHE EHRENBURG PHYSICIAN 40.00 X 427858 0 38812 TA THUC NGU DINH PHYSICIAN 40.00 X 402781 0 37442 TODD WAYNE MONROE PHYSICIAN 40.00 X 406919 0 23208 HEIDI LEE MILLER PHYSICIAN 40.00 X 350547 0 5551 TIHELE L WALKOUSKY PHYSICIAN 40.00 X 381554 0 15549 ROBERTO S JUAREZ FORMER CEO (THRU JUNE 2021) 40.00 X 639489 0 25573 4584018 0 263875 114 1 1 0 VENTURA COUNTY MEDICAL CENTER 800 S VICTORIA AVE VENTURA CA 93009 HEALTHCARE PROVIDER 1730723 QUEST DIAGNOSTICS INCORPORATED PO BOX 912411 PASADENA CA 91110 MEDICAL LAB SERVICES 1579326 PALMS IMAGING MEDICAL GROUP INC PO BOX 190 SIMI VALLEY CA 93062 DIAGNOSTIC IMAGING PROVIDER 1197763 TWO TREES PHYSICAL THERAPY 3418 LOMA VISTA RD VENTURA CA 93033 HEALTHCARE PROVIDER 1170985 BEVERLY RADIOLOGY MEDICAL GROUP PO BOX 101418 PASADENA CA 91189 DIAGNOSTIC IMAGING PROVIDER 815741 72 24041788 23895 24065683 PATIENT SERVICE REVENUE 621400 85524012 85524012 340(B) PHARMACY REVENUE 446110 2021020 2021020 87545032 568550 568550 297023 297023 297023 112476288 87545032 0 865573 X 1911110 1911110 52628809 40983685 11645124 1068898 830384 238514 9352150 6676834 2675316 3699395 2622220 1077175 617772 617772 3063622 3063622 136065 136065 30210316 29342214 868102 1484051 1473645 10406 2134116 1343925 790191 924519 877754 46765 1337366 965995 371371 172270 103057 69213 282855 150136 132719 548420 518634 29786 3009365 492186 2517179 994246 819971 174275 SUPPLIES 5724933 5660283 64650 TAXES & LICENSES 1122755 542416 580339 REPAIRS & MAINTENANCE 926762 360290 566472 EQUIPMENT RENTALS 796628 474321 322307 707673 42743 664930 122854096 94280693 28573403 0 5268900 16584 68131276 39312567 22277087 341262 7623407 9080358 1340881 734810 125355677 39552717 69040564 85802960 27503589 24811375 1848060 1848060 4232060 10137240 207265824 172085216 30955498 31412772 100000 295500 69579498 70019683 276695 246580 11068016 12563376 111979707 114537911 X 73286495 57547305 21999622 0 95286117 57547305 207265824 172085216 -10377808 -5783201 -21577803 0 X 0 1 X 1 1 1 X 15486150 16216000 21701214 29985344 24065683 107454391 84938153 94362273 93038696 111412476 87842055 471593653 100424303 110578273 114739910 141397820 111907738 579048044 0 0 0 579048044 773649 1155065 1450677 678314 568550 4626255 773649 1155065 1450677 678314 568550 4626255 101197952 111733338 116190587 142076134 112476288 583674299 0.99210 0.00790 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10679982 10679982 53823399 21834481 31988918 20255014 7087657 13167357 11304892 10346158 958734 29292390 284421 29007969 85802960 ESTIMATED THIRD-PARTY PAYOR RECEIVABLES 5597196 SECURITY DEPOSITS 31785 RELATED PARTY NOTES RECEIVABLE 4508259 10137240 ESTIMATED THIRD-PARTY PAYOR LIABILITIES 12563376 12563376 X X 1 0 0 0 0 0 0 1 0 ROBERTO S JUAREZ FORMER CEO (THRU JUNE 2021) 326570 0 0 0 312919 0 17575 0 7998 0 665062 0 0 0 CHRISTINA M VELASCO CFO (THRU SEPTEMBER 2021) 307171 0 52247 0 142995 0 6450 0 12360 0 521223 0 0 0 GAGAN PAWAR CEO 382695 0 53747 0 0 0 15362 0 16972 0 468776 0 0 0 MENASHE EHRENBURG PHYSICIAN 426358 0 1500 0 0 0 11781 0 27031 0 466670 0 0 0 TA THUC NGU DINH PHYSICIAN 401281 0 1500 0 0 0 12000 0 25442 0 440223 0 0 0 TODD WAYNE MONROE PHYSICIAN 405419 0 1500 0 0 0 0 0 23208 0 430127 0 0 0 TIHELE L WALKOUSKY PHYSICIAN 379054 0 2500 0 0 0 9998 0 5551 0 397103 0 0 0 ANTONIO ALATORRE CBDO 349099 0 1750 0 18680 0 2445 0 16320 0 388294 0 0 0 HEIDI LEE MILLER PHYSICIAN 349047 0 1500 0 0 0 0 0 5551 0 356098 0 0 0 KELLY LYNN BENNETT HR DIRECTOR 217041 0 44715 0 0 0 5850 0 18621 0 286227 0 0 0 ANWAR ALI ABBAS CIO 217551 0 1000 0 0 0 0 0 14512 0 233063 0 0 0 ANNA BELL MONROY COO 184679 0 1500 0 0 0 0 0 8848 0 195027 0 0 0 PART I, LINE 4A DURING CALENDAR YEAR 2021, ROBERTO S. JUAREZ, THE FORMER CEO, RECEIVED A SEVERANCE PLAN PAYMENT IN THE AMOUNT OF $233,750. PART I, LINE 7 NONFIXED PAYMENTS INCLUDE HOLIDAY AND OTHER BONUSES. HOLIDAY BONUSES ARE GIVEN BASED ON TIME WORKED AT THE COMPANY. AT YEAR END, THE CEO WILL PROPOSE TO THE BOARD OF DIRECTORS ADDITIONAL BONUSES FOR MANAGEMENT BASED ON VARIOUS COMPANY PERFORMANCE MEASURES. THE BOARD APPROVES THE AMOUNTS TO AWARD. A CALIFORNIA MUNICIPAL FINANCE AUTHORITY 201563466 13048VNU8 2020-03-19 71427330 REFINANCE DEBT & CONSTRUCTION 0 0 0 A 965000 71427330 1250253 1982868 927699 36634941 28432480 4181957 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREAPRED BY AN INDEPENDENT CPA AND THEN REVIEWED BY THE CFO. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION INVESTIGATES POTENTIAL CONFLICTS OF INTEREST WHEN THEY ARISE BY COMPLIANCE STAFF. ALL STAFF ARE COVERED UNDER THE CONFLICT OF INTEREST POLICIES. STAFF ARE REQUIRED TO SELF-REPORT ANY CONFLICT OF INTEREST AND DOCUMENT THE CONFLICT. CONFLICTS ARE REVIEWED BY COMPLIANCE AND SUPERVISING STAFF. DETERMINATIONS ARE MADE AS TO THE VIABILITY OF USING VENDORS/CONTRACTORS FOR COMPANY ACTIVITY AND WOULD PRECLUDE ANY CONFLICTED CDCR EMPLOYEE FROM BEING INVOLVED IN THE DECISION MAKING AND APPROVAL PROCESS. ANY VIOLATIONS ARE HANDLED IN ACCORDANCE WITH THE WRITTEN POLICIES AND PROCEDURES. FORM 990, PART VI, SECTION B, LINE 15 EVERY YEAR THE BOARD OF DIRECTORS FINANCE COMMITTEE EVALUATES THE CEO'S PERFORMANCE AND COMPENSATION. ANNUALLY THE CEO AND HR DIRECTOR WORK TOGETHER USING STATE AND NATIONALLY BASED SALARY SURVEYS TO COMPARE THE CORPORATION'S OFFICERS' SALARIES TO THOSE OF SIMILAR CORPORATIONS. COMPARISON SURVEYS ARE PERFORMED BY THE CEO AND HUMAN RESOURCES DIRECTOR USING STATE AND NATIONAL DATABASES. ANNUAL REVIEWS ARE PERFORMED BY THE BOARD OF DIRECTORS FOR ALL OFFICERS, KEY EMPLOYEES, AND OTHER HIGHLY COMPENSATED EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 FORM 990 IS AVAILABLE FOR REVIEW AT THE ORGANIZATIONS ADMINISTRATIVE OFFICE DURING NORMAL BUSINESS HOURS. OTHER FORMS SUCH AS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE INTERNAL CORPORATE DOCUMENTS. FORM 990, PART IX, LINE 11G CLINICAL SERVICES: PROGRAM SERVICE EXPENSES 21,420,385. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,420,385. LAB SERVICES: PROGRAM SERVICE EXPENSES 2,522,787. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,522,787. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 5,399,042. MANAGEMENT AND GENERAL EXPENSES 868,102. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,267,144. AMERICASHEALTH PLAN INC 1000 TOWN CENTER DRIVE SUITE 410 OXNARD CA 93036 271073990 MANAGED CARE HEALTH PLAN CA CLINICAS DEL CAMINO REAL INC C 25428898 8169218 1.00000 1 MEDPARTNERS MSO INCORPORATED 1040 FLYNN RD CAMARILLO CA 93012 814231443 INSURANCE BILLING CA CLINICAS DEL CAMINO REAL INC C 6016238 4590723 1.00000 1 1 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 AMERICASHEALTH PLAN INC A 25921 CASH AMERICASHEALTH PLAN INC D 1235000 CASH AMERICASHEALTH PLAN INC L 1261088 CASH MEDPARTNERS MSO INCORPORATED INC A 99936 CASH MEDPARTNERS MSO INCORPORATED INC M 6373363 CASH