2024-02-20T16:59:30-06:00 2023-05-31 910189318 MOSS ADAMS LLP 221 STEWART AVENUE SUITE 301 MEDFORD OR 97501 990 2022-06-01 943096772 LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC LACL 5415356239 931 CHEVY WAY MEDFORD OR 97504 MAHEA KAEO-WAILEHUE CFO 5415356239 2024-02-20 1 MAHEA KAEO-WAILEHUE 999009999 0 APRIL STITH P01245039 5418571040 2024-02-20 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MAHEA KAEO-WAILEHUA 931 CHEVY WAY MEDFORD OR 97504 56141003 0 X WWW.LACLINICAHEALTH.ORG X 1988 OR LA CLINICA PROVIDES PRIMARY AND PREVENTIVE MEDICAL, DENTAL, BEHAVIORAL HEALTH, AND OTHER HEALTH PROMOTION SERVICES TO UNDERSERVED AND LOW-INCOME PATIENTS. 14 14 487 63 0 0 13823494 17968670 33719054 37641536 285944 403072 72265 127725 47900757 56141003 0 0 0 0 29322152 33093364 0 0 584666 10500510 13059848 39822662 46153212 8078095 9987791 55035443 65449211 8661907 9047527 46373536 56401684 LA CLINICA PROVIDES PRIMARY AND PREVENTIVE MEDICAL, DENTAL, BEHAVIORAL HEALTH, AND OTHER HEALTH PROMOTION SERVICES TO UNDERSERVED AND LOW-INCOME PATIENTS. 0 0 34426374 37769261 LA CLINICA PROVIDES COMPREHENSIVE PREVENTIVE MEDICAL AND DENTAL CARE, AS WELL AS INTEGRATED BEHAVIORAL HEALTH, PRENATAL CARE AND GYNECOLOGY, PHYSICAL THERAPY, ACUPUNCTURE, AND ADVANCED CARE IN RHEUMATOLOGY AND GASTROENTEROLOGY. WE ENGAGE OVER 400 EMPLOYEES WHO PROVIDE HIGH QUALITY SERVICES AT TWENTY-FIVE SERVICE SITES, INCLUDING TWO SITES THAT HOUSE A COMMUNITY PHARMACY. THE COMMUNITY PHARMACIES PROVIDE DIRECT PATIENT BENEFIT BY OFFERING LOW PRESCRIPTION COSTS AND RETAIL PHARMACY ACCESS TO THOSE WE SERVE AND THEIR FAMILIES. TO HELP OUR COMMUNITY ACCESS CARE, WE ACCEPT ALL INSURANCE TYPES AND OFFER A GENEROUS SLIDING SCALE FOR LOW-INCOME UNINSURED AND UNDERINSURED PATIENTS. WE ALSO UTILIZE THE FEDERAL 340B DRUG PRICING PROGRAM TO OFFER DEEPLY DISCOUNTED MEDICATIONS TO OUR PATIENTS. 34426374 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 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 0 0 0 0 1 53 0 1 487 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X MAHEA KAEO-WAILEHUA 5415123130 931 CHEVY WAY MEDFORD OR 97504 LINDA REID PRESIDENT 2.00 X X 0 0 0 MONICA MORALES VICE PRESIDENT 2.00 X X 0 0 0 LINDSEY TRAUTMAN TREASURER 2.00 X X 0 0 0 PAUL ROSTYKUS SECRETARY 2.00 X X 0 0 0 TIGHE O'MEARA PAST PRESIDENT (FORMER) 2.00 X 0 0 0 VICTORIA BENCOMO BOARD MEMBER 2.00 X 0 0 0 SARA COLLINS BOARD MEMBER 2.00 X 0 0 0 LARRY GIBBS BOARD MEMBER 2.00 X 0 0 0 SCOTT LEWIS BOARD MEMBER 2.00 X 0 0 0 LYNNE LOWE BOARD MEMBER 2.00 X 0 0 0 LISA PARKS BOARD MEMBER 2.00 X 0 0 0 JEANNE PICKENS BOARD MEMBER 2.00 X 0 0 0 BRAD RUSSELL BOARD MEMBER 2.00 X 0 0 0 KARIN TRUJILLO BOARD MEMBER 2.00 X 0 0 0 CHRISTIE VAN AKEN BOARD MEMBER 2.00 X 0 0 0 BRENDA JOHNSON RN MBA CEO 40.00 X 279709 0 23464 JILL BOROVANSKY CFO (FORMER) 40.00 X 111247 0 15119 MAHEA KAEO-WAILEHUA CFO 40.00 X 82848 0 8827 TARA JEANNOT COO 40.00 X 136466 0 13767 JUSTIN ADAMS CHIEF MEDICAL OFFICER 40.00 X 266495 0 17940 AMY FINE CHIEF DENTAL OFFICER 40.00 X 228933 0 22234 KAREN SAUER MEDICAL OFFICER 33.00 X 213083 0 26998 JAMIE OSBORN POPULATION HEALTH OFFICER 40.00 X 214969 0 23538 TRACI FOSSEN CHIEF QUALITY OFFICER 40.00 X 144107 0 11873 1677857 0 163760 12 0 1 0 0 15915842 2052828 17968670 NET MEDICAL FEES 621110 37641536 37641536 37641536 80638 80638 227585 94849 0 0 227585 94849 322434 322434 MISC INCOME 621110 127725 127725 127725 56141003 37769261 0 403072 671448 671448 25994517 21105107 4437357 452053 4244702 3242073 933454 69175 2182697 1667128 479998 35571 647050 425634 221416 9712 6389 3323 103615 68159 35456 537165 236183 290221 10761 4792830 4553693 235051 4086 1247856 279922 965715 2219 395782 240642 150667 4473 99116 99116 1116922 136874 980048 249549 85204 164345 CONTRACTUAL 3060159 1971791 1086629 1739 MISCELLANEOUS EXPENSES 512866 205431 302846 4589 EQUIPMENT REPAIRS 287226 202144 85082 0 46153212 34426374 11142172 584666 25909306 22398128 374742 556550 3984739 4859417 835644 982491 300500 611819 32116940 10856001 20757193 21260939 939204 12715159 1382438 1315554 71863 59359 479814 689795 55035443 65449211 3314195 3966879 854010 646411 3696049 3513343 317839 225095 479814 695799 8661907 9047527 X 44991098 55086130 1382438 1315554 46373536 56401684 55035443 65449211 9987791 40357 0 X 0 1 X 1 1 1 X 9687448 10655075 18466192 13823494 17968670 70600879 9687448 10655075 18466192 13823494 17968670 70600879 70600879 84933 43936 41317 80638 250824 9591 9591 70861294 132115758 0.99630 0.99670 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1382438 -66884 1315554 1221057 161381 1382438 900334 320723 1221057 956842 -47960 8548 900334 916268 48373 7798 956843 1.00000 1 0 4378976 4378976 22444062 6730850 15713212 5293902 4125151 1168751 21260939 LEASE LIABILITIES 695799 695799 X 56181360 40357 40357 56141003 0 56141003 46153212 0 46153212 0 46153212 PART X, LINE 2: LA CLINICA HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED ACTIVITIES. NO TAX PROVISION HAS BEEN MADE IN THE ACCOMPANYING STATEMENT OF ACTIVITIES. LA CLINICA RECOGNIZES THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITIONS WILL BE SUSTAINED ON EXAMINATION BY THE TAX AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFIT IS MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. LA CLINICA RECOGNIZES INTEREST AND PENALTIES RELATED TO INCOME TAX MATTERS IN OPERATING EXPENSES. AS OF MAY 31, 2023, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS. X X X X X 0 0 0 0 0 0 0 0 0 BRENDA JOHNSON RN MBA CEO 279709 0 0 0 0 0 20500 0 2964 0 303173 0 0 0 JUSTIN ADAMS CHIEF MEDICAL OFFICER 262555 0 0 0 3940 0 13798 0 4142 0 284435 0 0 0 AMY FINE CHIEF DENTAL OFFICER 228933 0 0 0 0 0 19042 0 3192 0 251167 0 0 0 KAREN SAUER MEDICAL OFFICER 211078 0 0 0 2005 0 24292 0 2706 0 240081 0 0 0 JAMIE OSBORN POPULATION HEALTH OFFICER 212546 0 1388 0 1035 0 20500 0 3038 0 238507 0 0 0 TRACI FOSSEN CHIEF QUALITY OFFICER 144107 0 0 0 0 0 8829 0 3044 0 155980 0 0 0 TARA JEANNOT COO 136466 0 0 0 0 0 5960 0 7807 0 150233 0 0 0 A STATE OF OREGON OREGON FACILITIES AUTHORITY 936001787 2018-10-31 4105473 CHEVY WAY BUILDING 0 0 0 A 4105473 2018 0 0 1 1 A 0 0 0 0 1 0 1 A 0 0 0 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 7A A NOMINATING COMMITTEE SHALL NOMINATE CANDIDATES FOR BOARD APPROVAL TO FILL BOARD MEMBER VACANCIES. THE NOMINATING COMMITTEE SHALL MAINTAIN A CURRENT PROFILE OF THE BOARD'S MEMBERSHIP COMPOSITION TO GUIDE THE SELECTION PROCESS. IT SHALL REVIEW THE PERFORMANCE OF INCUMBENT BOARD MEMBERS WHO ARE ELIGIBLE FOR RE-ELECTION, AND IF APPROPRIATE, RECOMMEND THEM TO THE BOARD OF DIRECTORS FOR NOMINATION AND RE-ELECTION. THE COMMITTEE SHALL, SUBJECT TO THE REQUIREMENTS SET FORTH IN THE BY-LAWS, ALSO NOMINATE MEMBERS-AT-LARGE. CANDIDATES NOMINATED TO FILL BOARD POSITIONS WILL BE ELECTED BY A MAJORITY VOTE OF THE MEMBERS AT A BOARD MEETING AT WHICH A QUORUM IS PRESENT. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 PREPARER PROVIDES A DRAFT COPY OF THE FORM 990 TO THE CFO AND THE ACCOUNTING MANAGER. A COPY OF THE FORM 990 IS ALSO PROVIDED TO THE FINANCE/AUDIT COMMITTEE FOR REVIEW. FINALLY, THE BOARD IS NOTIFIED OF ANY FINDINGS AND PROVIDED A FINAL DRAFT TO REVIEW PRIOR TO FILING. AFTER FINAL REVIEW, THE FORM 990 PREPARER IS NOTIFIED TO FILE THE FORM 990. A REPORT IS THEN PROVIDED TO THE FULL BOARD OF DIRECTORS ON THE RESULTS OF THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY IN PLACE THAT IS DISTRIBUTED TO ALL NEW HIRES AND INCOMING BOTKRD MEMBERS AND REVIEWED ANNUALLY FOR UPDATES. THE POLICY STATES THAT ANY CONFLICTS OF INTEREST BE DISCLOSED AS SOON AS THE WORKFORCE OR BOARD MEMBER BECOMES AWARE OF THE CONFLICT. CONFLICT OF INTEREST DISCLOSURE FORMS ARE COMPLETED BY ALL BOARD MEMBERS EACH YEAR. FORM 990, PART VI, SECTION B, LINE 15 15A: THE BOARD OF DIRECTORS IS RESPONSIBLE TO HIRE AND REMOVE THE CHIEF EXECUTIVE OFFICER, SUPPORT AND ASSESS HIS OR HER PERFORMANCE, AND ENSURE THAT THE CHIEF EXECUTIVE HAS THE MORAL AND PROFESSIONAL SUPPORT NEEDED TO FURTHER THE GOALS OF THE ORGANIZATION. EACH YEAR A MARKET REVIEW IS PERFORMED FOR A COMPETITIVE ANALYSIS OF SALARIES IN THE LOCAL AND REGIONAL AREAS FOR THE CEO. THE AUTHOR OF THE MARKET REVIEW INDICATES A RANGE IN WHICH THE CEO'S SALARY SHOULD SIT AND REPORTS THIS TO THE PRESIDENT. THE EXECUTIVE COMMITTEE MEETS TO DISCUSS A PAY CHANGE AND MAKES A RECOMMENDATION TO THE BOARD, WHICH VOTE IN JUNE TO ADOPT THE PAY CHANGE OR NOT DEPENDING UPON THE BUDGETED FINANCIAL FORECAST OF THE ORGANIZATION. 15B: EACH YEAR A MARKET REVIEW IS PERFORMED FOR A COMPETITIVE ANALYSIS OF SALARIES IN THE LOCAL AND REGIONAL AREAS FOR ALL POSITIONS IN THE ORGANIZATION. THE HUMAN RESOURCE DIRECTOR COMPILES THE INFORMATION, AND AFTER APPROVAL FROM THE CEO, IT IS GIVEN TO THE ACCOUNTING MANAGER, WHO INPUTS THE DATA INTO THE FORECASTED BUDGET FOR THE NEXT FISCAL YEAR. INCREASES IN BASE PAY MAY BE INCLUDED FOR NEW BUDGET PERIODS (BEGINNING IN JUNE) IF THE FOLLOWING IS TRUE: 1. FINANCIAL FORECAST FOR THE ORGANIZATION IS HEALTHY; 2. THE SALARY FOR THE JOB POSITION HAS FALLEN BELOW THE AVERAGE MARKET RANGE AND PAY THRESHOLD FOR THE ORGANIZATION; 3. THE BOARD OF DIRECTORS HAS REVIEWED AND APPROVED THE NEW BUDGET INCLUDING THE CHANGES TO SALARIES AND WAGES. FORM 990, PART VI, SECTION C, LINE 19 LA CLINICA DEL VALLE MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AS PER THE FOLLOWING POLICY GUIDELINES: THE AUDITED FINANCIAL STATEMENTS WILL BE DISTRIBUTED TO THE BOARD OF DIRECTORS, TO REGULATORY AGENCIES AND TO ORGANIZATIONS ENTITLED TO RECEIVE A COPY DUE TO CONTRACTUAL AGREEMENT. THE AUTHORITY TO DISTRIBUTE THE STATEMENTS TO OTHER INDIVIDUALS OR FIRMS REQUESTING THEM WILL BE LEFT TO THE DISCRETION OF THE CHIEF EXECUTIVE OFFICERAND THE CHIEF FINANCIAL OFFICER.