2024-05-10T11:34:38-05:00 2023-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2022-07-01 941744108 LA CLINICA DE LA RAZA INC LACL 5105354000 PO BOX 22210 OAKLAND CA 946232210 KANWAR SINGH CFO 5105354000 2024-05-09 1 KANWAR SINGH 999009999 0 MICHAEL LUMSDEN P01262236 4159561500 2024-05-09 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JANE GARCIA PO BOX 22210 OAKLAND CA 946232210 148462806 0 X WWW.LACLINICA.ORG X 1971 CA COMPREHENSIVE MEDICAL SERVICES TO INDIVIDUALS IN NEED, REGARDLESS OF RACE, AGE, OR ABILITY TO PAY. 15 15 1371 178 0 0 60102978 47928073 84417493 99340815 -402557 48397 0 -26545 144117914 147290740 0 0 0 0 93827804 102012217 0 0 244165 39556010 47439683 133383814 149451900 10734100 -2161160 146079089 140718819 72618748 69057770 73460341 71661049 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 114187002 0 99340815 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 OVER 90,000 PATIENTS DURING THE FISCAL YEAR-ENDING JUNE 30, 2023. 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; TWO MEDICAL CLINICS IN NORTH VALLEJO; AND A MEDICAL, DENTAL, AND OPTICAL 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; ONE DENTAL CLINIC AT A YOUTH CENTER; AND PROVIDES PERIODIC DENTAL SCREENINGS AND TREATMENTS TO ABOUT 30 SCHOOLS IN ALAMEDA AND CONTRA COSTA COUNTIES. 114187002 1 1 0 1 0 0 0 0 0 0 1 0 1 1 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 1 0 0 0 1 1 1 0 0 1 250 0 1 1371 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X KANWAR SINGH 5105352915 1450 FRUITVALE AVENUE THIRD FLOOR OAKLAND CA 94601 JANE GARCIA CHIEF EXECUTIVE OFFICER 40.00 1.00 X 624588 0 84839 JORGE SIOPACK MD FACOG PHYSICIAN OB/GYN 40.00 0.00 X 337876 0 3182 PAUL BAYARD MD MPH CHIEF MEDICAL OFFICER 40.00 0.00 X 284248 0 28227 JOHN MURPHY MD MEDICAL INFORMATION OFFICER 40.00 0.00 X 247082 0 28227 LISA MONTANG MD PHYSICIAN ASSOCIATE MEDICAL DIRECTOR 40.00 0.00 X 224711 0 28227 SAMANTHA VARNER MD PHYSICIAN OB/GYN 40.00 0.00 X 244961 0 6954 JUAN E VARGAS MD LEAD OB/GYN 40.00 0.00 X 245839 0 3182 MICHELE HERMAN MD PHYSICIAN ASSOCIATE MEDICAL DIRECTOR 40.00 0.00 X 224953 0 3182 FERNANDO CORTEZ CHIEF INFORMATION OFFICER 40.00 0.00 X 187813 0 39748 DOLLY DAVAR PHARMACY DIRECTOR 40.00 0.00 X 223489 0 3182 SUSAN MOORE CFO (THROUGH 11/2022) 40.00 1.00 X 196637 0 19528 ZENAIDA AGUILERA COMPLIANCE & PRIVACY OFFICER 40.00 0.00 X 151142 0 32011 ARIANE TERLET DDS CHIEF DENTAL OFFICER 40.00 0.00 X 144556 0 2277 KANWAR SINGH CFO (START 10/2022) 40.00 1.00 X 39472 0 9897 RAMON TERRAZAS MD MPH PRESIDENT 1.00 1.00 X X 0 0 0 ROBERT CALVIN KATTER 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 SOPHIA BUCHELI DIRECTOR 1.00 1.00 X 0 0 0 JON ELAM 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 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 JO ANN INTILI DIRECTOR 1.00 1.00 X 0 0 0 REVEREND RODNEY J LEGGET DIRECTOR 1.00 1.00 X 0 0 0 CARMEN MARTINEZ DIRECTOR 1.00 1.00 X 0 0 0 EMILY PRIETO-TSEREGOUNIS PHD DIRECTOR 1.00 1.00 X 0 0 0 TINA RAINE-BENNETT MD MPH FACOG DIRECTOR 1.00 1.00 X 0 0 0 3377367 0 292663 170 0 1 0 PORT53 TECHNOLOGIES INC ONE EMBARCADERO CENTER 4150 SAN FRANCISCO CA 94111 IT SECURITY SERVICES 8385279 OCHIN INC 1881 SW NAITO PKWY PORTLAND OR 97201 IT SERVICES 2292808 SECURITY ENFORCEMENT ALLIANCE INC 1516 NAPA STREET NAPA CA 94590 SECURITY SERVICES 1615009 TOWNSHIP BUILDING SERVICES INC 26 PAMARON WAY SUITE A NOVATO CA 94949 MAINTENANCE SERVICES 1288400 MED TECH SOLUTIONS LLC PO BOX 748882 LOS ANGELES CA 90074 IT SERVICES 700521 32 221581 40901847 6804645 1207140 47928073 NET PATIENT REVENUE 621400 86346170 86346170 CAPITATION REVENUE 621400 8561566 8561566 PHARMACY - 340B PROG REV 621400 2227737 2227737 OTHER OPERATING REV 621400 2205342 2205342 99340815 1093385 1093385 1044988 -1044988 -1044988 -1044988 97813 221581 127078 -29265 -29265 2720 0 2720 2720 147290740 99340815 0 21852 2625403 1000668 1624735 73885599 62949897 10815012 120690 2066104 1788573 273809 3722 17628075 14732050 2867954 28071 5807036 4864147 933700 9189 88671 16518 72153 165628 108 165520 11701033 10133699 1547487 19847 122409 87539 11737 23133 4022485 2800120 1203204 19161 6791356 159009 6630742 1605 4742758 3796085 946343 330 206892 145611 61281 25335 14254 10616 465 798105 730097 68008 3261512 2050625 1210619 268 488519 488519 MEDICAL SUPPLIES 8552094 8552094 LEGAL SETTLEMENT 5500000 5500000 TAXES & FEES 572089 193777 367766 10546 DUES & SUBSCRIPTIONS 219782 11528 202050 6204 181015 160603 19478 934 149451900 114187002 35020733 244165 13378357 6683581 4834889 2750062 7977532 6896548 7603420 10106188 12038400 12038400 417218 346455 3559774 6098700 68587430 34156226 33921647 34431204 25704545 25965847 7817869 7817869 28825438 27583965 146079089 140718819 13538190 12524762 5371618 5362255 5867302 5540755 5912961 5429162 41928677 40200836 72618748 69057770 X 65952747 64307571 7507594 7353478 73460341 71661049 146079089 140718819 -2161160 361868 0 X 0 1 X 1 1 1 X 33465986 42112569 45297672 60102978 47928073 228907278 33465986 42112569 45297672 60102978 47928073 228907278 828264 228079014 680579 503910 774074 204537 1093385 3256485 154105 145796 299901 232463664 414856825 0.98110 0.98220 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 3820 0 0 3820 0 PART II-B, LINE 1: THE ORGANIZATION'S LOBBYING ACTIVITIES ARE LARGELY ATTRIBUTABLE TO MEETINGS THE ORGANIZATION PARTICIPATED WITH IN CONJUNCTION WITH SIMILAR, OUTSIDE ORGANIZATIONS PERTAINING TO VARIOUS LEGISLATIVE ISSUES IMPACTING THE HEALTH CARE FIELD AND/OR THE COMMUNITY LA CLINICA SERVES. 2085517 2085517 34912530 16907540 18004990 7425977 3180319 4245658 22180163 14068367 8111796 1983243 1983243 34431204 INVESTMENT IN LA CLINICA GEORGIA STREET 7817869 C 7817869 DEPOSITS 819989 OPERATING LEASE RIGHT OF USE ASSETS 26763976 27583965 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 7705630 OPERATING LEASE LIABILITIES 26995206 ACCRUED LEGAL SETTLEMENT 5500000 40200836 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, 2023 AND 2022, 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. 2022 ALL THAT JAZZ 319394 221581 97813 22450 54243 21120 29265 319394 221581 97813 22450 54243 21120 29265 127078 -29265 X X 0 1 0 0 0 0 0 0 0 JANE GARCIA CHIEF EXECUTIVE OFFICER 405484 0 50300 0 168804 0 65682 0 19157 0 709427 0 86477 0 JORGE SIOPACK MD FACOG PHYSICIAN OB/GYN 336576 0 300 0 1000 0 3182 0 0 0 341058 0 0 0 PAUL BAYARD MD MPH CHIEF MEDICAL OFFICER 282948 0 300 0 1000 0 3182 0 25045 0 312475 0 0 0 JOHN MURPHY MD MEDICAL INFORMATION OFFICER 245782 0 300 0 1000 0 3182 0 25045 0 275309 0 0 0 LISA MONTANG MD PHYSICIAN ASSOCIATE MEDICAL DIRECTOR 223746 0 0 0 965 0 3182 0 25045 0 252938 0 0 0 SAMANTHA VARNER MD PHYSICIAN OB/GYN 244142 0 0 0 819 0 3182 0 3772 0 251915 0 0 0 JUAN E VARGAS MD LEAD OB/GYN 245139 0 0 0 700 0 3182 0 0 0 249021 0 0 0 MICHELE HERMAN MD PHYSICIAN ASSOCIATE MEDICAL DIRECTOR 223653 0 300 0 1000 0 3182 0 0 0 228135 0 0 0 FERNANDO CORTEZ CHIEF INFORMATION OFFICER 186813 0 0 0 1000 0 3182 0 36566 0 227561 0 0 0 DOLLY DAVAR PHARMACY DIRECTOR 222289 0 300 0 900 0 3182 0 0 0 226671 0 0 0 SUSAN MOORE CFO (THROUGH 11/2022) 194837 0 800 0 1000 0 2058 0 17470 0 216165 0 0 0 ZENAIDA AGUILERA COMPLIANCE & PRIVACY OFFICER 149942 0 200 0 1000 0 23222 0 8789 0 183153 0 0 0 PART I, LINE 4B JANE GARCIA PARTICIPATES IN A SUPPLEMENTAL, NONQUALIFIED 457(F) RETIREMENT PLAN SPONSORED BY THE ORGANIZATION. DURING THE 2022 CALENDAR YEAR, EMPLOYER CONTRIBUTIONS TO THE PLAN TOTALED $42,000 WHICH HAS BEEN REPORTED AS "DEFERRED COMPENSATION" ON SCHEDULE J, PART II, COLUMN (C). IN ADDITION, DUE TO VESTING OF THE 457(F) RETIREMENT PLAN, $86,477 WAS RECOGNIZED AS TAXABLE COMPENSATION ON JANE GARCIA'S 2022 FORM W-2 WHICH HAS BEEN RECORDED WITHIN "OTHER REPORTABLE COMPENSATION" ON SCHEDULE J, PART II, COLUMN (B)(III) AND "COMPENSATION IN COLUMN (B) REPORTED AS DEFERRED ON PRIOR FORM 990" ON SCHEDULE J, PART II, COLUMN (F). 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 1980000 3855000 3855000 2011 0 0 1 1 B 353972 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 2 2145 FAIR MARKET VALUE X 13641 FAIR MARKET VALUE X 3 280 FAIR MARKET VALUE X 4685 1177123 COST OF DONATED PROPERTY X AUCTION DONATIONS 46 13951 FAIR MARKET VALUE 0 0 1 0 PART I, COLUMN (B): THE ORGANIZATION IS REPORTING THE NUMBER OF ITEMS DONATED 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 ARE 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 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 LA CLINICA VALLEJO GEORGIA STREET PROPERTY OWNER K 230004 BOOK / ACTUAL VALUE