2024-04-23T17:21:51-05:00 2023-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2022-07-01 942191935 EAST VALLEY COMMUNITY CLINIC INC EAST 4082747100 2470 ALVIN AVENUE 60 SAN JOSE CA 95121 STACY CROSS EXECUTIVE DIRECTOR 4082747100 2024-04-22 1 STACY CROSS 999009999 0 MICHAEL LUMSDEN P01262236 4159561500 2024-04-21 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MAR MONTE COMMUNITY CLINIC STACY CROSS 2470 ALVIN AVENUE 60 SAN JOSE CA 95121 696888 0 X N/A X 1973 CA TO PROVIDE HEALTH CARE AND EDUCATION TO INDIVIDUALS AND FAMILIES IN EAST SAN JOSE. 4 3 19 3 0 0 316625 46034 2273869 627407 0 0 1005 23447 2591499 696888 0 0 0 0 1597015 1533623 0 0 0 745351 1001583 2342366 2535206 249133 -1838318 3824349 2208240 251153 473362 3573196 1734878 TO PROVIDE HEALTH CARE AND EDUCATION TO INDIVIDUALS AND FAMILIES IN EAST SAN JOSE. 0 0 2505411 0 627407 PATIENT SERVICES - THE PRIMARY CARE CLINIC AND THE PEDIATRIC CARE CLINIC OFFER DIAGNOSIS AND TREATMENT OF ACUTE AND CHRONIC ILLNESSES, PREVENTIVE HEALTH CARE, AND SCREENINGS FOR MEDICAL CONDITIONS SUCH AS DIABETES, HIGH BLOOD PRESSURE AND HIV INFECTION. THE COMPREHENSIVE PRENATAL AND OUTREACH PROGRAM PROVIDE SERVICES THAT CONTRIBUTE TO THE COUNTY OF SANTA CLARA'S EFFORT TO DEVELOP AND IMPLEMENT A PRENATAL OUTREACH AND CASE FINDING SYSTEM. THE REPRODUCTIVE HEALTH PROGRAM PROVIDES PRE-MARITAL BLOOD TESTS, DIAGNOSIS OF SEXUALLY TRANSMITTED DISEASE, HIV/AIDS RISK ASSESSMENT AND INFORMATION AND COUNSELING REGARDING FAMILY PLANNING. PATIENT SERVICES FUNDING SOURCES INCLUDE FEES PAID BY PATIENTS AND BY MEDI-CAL, AS WELL AS GRANTS FROM VARIOUS PUBLIC AND PRIVATE AGENCIES. 2505411 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 4 0 1 19 1 0 0 0 0 0 0 0 0 0 0 0 0 X 4 3 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X JOANNE PARISE 4087953715 1691 THE ALAMEDA SAN JOSE CA 95126 ELIZABETH DAVILA CHAIR 1.00 0.00 X X 0 0 0 JOAN GALLO SECRETARY 1.00 0.00 X X 0 0 0 STACY CROSS BOARD MEMBER / EXECUTIVE DIRECTOR 5.00 45.00 X X 0 669149 56522 TANUJA BAHAL BOARD MEMBER 1.00 0.00 X 0 0 0 THOMAS MOTSIFF CHIEF ADMIN & FINANCIAL OFFICER 5.00 45.00 X 0 446134 30166 ESTHER KIANG CLINICIAN 40.00 0.00 X 106728 0 8713 ANH PHAM CLINICIAN 40.00 0.00 X 139104 0 10809 TERESA ROBBINS MD PHYSICIAN 32.00 0.00 X 226995 0 7455 CHRISTINE SO CLINICIAN 40.00 0.00 X 119780 0 12239 MIRIAM ZELEDON HEALTH CENTER MANAGER 40.00 0.00 X 106841 0 16667 DOMINIQUE LEE FORMER EXECUTIVE DIRECTOR 0.00 0.00 X 0 505249 9890 699448 1620532 152461 5 1 1 0 0 46034 46034 NET PATIENT SERVICE REVENUE 624100 627407 627407 627407 MISCELLANEOUS REVENUE 900099 23447 23447 23447 696888 627407 0 23447 1273508 1273508 49037 49037 120212 120212 90866 90866 29795 29795 192106 192106 185 185 59223 59223 7728 7728 219052 219052 1309 1309 5098 5098 2013 2013 11739 11739 23189 23189 MEDICAL SUPPLIES 408100 408100 EQUIP RENTAL & MAINT 26854 26854 SUBSCRIPTIONS 7838 7838 SALES TAX 5869 5869 1485 1485 2535206 2505411 29795 0 849082 1342441 73402 0 2751955 532978 6889 32068 17051 8551 774735 729327 0 45408 125970 246794 3824349 2208240 247558 267552 3595 205810 251153 473362 X 3573196 1734878 3573196 1734878 3824349 2208240 -1838318 0 X 0 1 X 1 0 X 904494 675625 615092 316625 46034 2557870 904494 675625 615092 316625 46034 2557870 2557870 178930 59563 170488 1005 23447 433433 2991303 9571311 0.85510 0.86960 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2018 AMOUNT: $ 178,930. 2019 AMOUNT: $ 59,563. 2020 AMOUNT: $ 170,488. 2021 AMOUNT: $ 1,005. 2022 AMOUNT: $ 23,447. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 659362 659362 0 69965 69965 0 45408 45408 45408 DUE FROM RELATED ORGANIZATION 155853 OPERATING LEASE - RIGHT-OF-USE ASSETS 90941 246794 DUE TO RELATED ORGANIZATION 117502 OPERATING LEASE LIABILITY 88308 205810 X 696888 0 696888 0 696888 2535206 0 2535206 0 2535206 PART X, LINE 2: EVCC 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, EVCC HAD NO UNRECOGNIZED TAX POSITIONS OR UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED IN THE FINANCIAL STATEMENTS. 1 0 0 0 0 0 0 0 0 STACY CROSS BOARD MEMBER / EXECUTIVE DIRECTOR 0 561441 0 107708 0 0 0 48538 0 7984 0 725671 0 0 DOMINIQUE LEE FORMER EXECUTIVE DIRECTOR 0 30904 0 0 0 474345 0 8952 0 938 0 515139 0 0 THOMAS MOTSIFF CHIEF ADMIN & FINANCIAL OFFICER 0 435985 0 10149 0 0 0 15250 0 14916 0 476300 0 0 TERESA ROBBINS MD PHYSICIAN 226197 0 798 0 0 0 7455 0 0 0 234450 0 0 0 PART I, LINE 3 THE ORGANIZATION'S EXECUTIVE DIRECTOR IS COMPENSATED BY PLANNED PARENTHOOD MAR MONTE, INC., A RELATED ORGANIZATION. PLANNED PARENTHOOD MAR MONTE, INC. UTILIZES THE FOLLOWING METHODS TO DETERMINE COMPENSATION OF THE EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE; INDEPENDENT COMPENSATION CONSULTANT; COMPENSATION SURVEY OR STUDY; AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4A DOMINIQUE LEE RECEIVED A TAXABLE SEVERANCE PAYMENT OF $385,000 FROM A RELATED ORGANIZATION DURING THE 2022 CALENDAR YEAR, WHICH HAS BEEN REPORTED WITHIN "OTHER REPORTABLE COMPENSATION" ON SCHEDULE J, PART II, COLUMN (B)(III). FORM 990, PART VI, SECTION A, LINE 6 EVCC HAS ONE SOLE CORPORATE MEMBER: PLANNED PARENTHOOD MAR MONTE, INC. FORM 990, PART VI, SECTION A, LINE 7A PLANNED PARENTHOOD MAR MONTE, INC. HAS THE POWER TO APPOINT ALL MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT TAX ACCOUNTANT IN CONJUNCTION WITH THE ORGANIZATION'S ACCOUNTING AND FINANCE DEPARTMENT. A DRAFT FORM 990 IS THEN REVIEWED BY THE EXECUTIVE DIRECTOR, CHIEF ADMINISTRATIVE AND FINANCIAL OFFICER, AND CONTROLLER OF PLANNED PARENTHOOD MAR MONTE, INC.; ADJUSTMENTS ARE MADE, AS NECESSARY. A COMPLETE COPY OF THE FORM 990 IS THEN PROVIDED TO ALL MEMBERS OF THE BOARD OF DIRECTORS FOR REVIEW AND COMMENT 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 ALL BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES ("INTERESTED PERSONS"). UNDER THE CONFLICT OF INTEREST POLICY, EACH INTERESTED PERSON SHALL ANNUALLY SIGN A STATEMENT THAT: (A) THE PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTOOD IT, AND HAS AGREED TO COMPLY WITH IT; AND (B) IF REQUIRED, DISCLOSES THE PERSON'S FINANCIAL INTERESTS AND FAMILY RELATIONSHIPS THAT COULD GIVE RISE TO ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. IN ADDITION, AN INTERESTED PERSON HAS AN ONGOING OBLIGATION TO PROMPTLY DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST GIVING RISE TO THE POTENTIAL CONFLICT OF INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE COMPLIANCE, QUALITY, AND RISK MANAGEMENT OVERSIGHT COMMITTEE ("CQRM OVERSIGHT COMMITTEE") OR, IN THE CASE OF A DIRECTOR, TO THE BOARD OF DIRECTORS, WHO WILL ASSESS THE POTENTIAL FOR CONFLICTS OF INTEREST ON BEHALF OF PPMM. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, THE DISINTERESTED MEMBERS OF THE BOARD OR CQRM OVERSIGHT COMMITTEE SHALL DECIDE: (I) WHETHER A CONFLICT OF INTEREST EXISTS AND, IF SO, (II) WHETHER TO ENTER INTO THE TRANSACTION. THE INTERESTED PERSONS SHALL NOT BE PRESENT DURING THE BOARD OR CQRM OVERSIGHT COMMITTEE'S FINAL DELIBERATIONS AND SHALL NOT VOTE ON ANY DECISIONS REGARDING THE MATTER. THE PROCEEDINGS ARE RECORDED WITHIN THE BOARD OR CQRM OVERSIGHT COMMITTEE MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE DIRECTOR AND CHIEF ADMINISTRATIVE AND FINANCIAL OFFICER ARE BOTH COMPENSATED BY PLANNED PARENTHOOD MAR MONTE, INC., A RELATED ORGANIZATION. ACCORDINGLY, FORM 990, PART VI, SECTION B, LINES 15A AND 15B HAVE BEEN ANSWERED "NO" IN ACCORDANCE WITH THE FORM 990 INSTRUCTIONS. PLEASE REFER TO THE PLANNED PARENTHOOD MAR MONTE, INC. FORM 990 FOR A DISCUSSION ON HOW COMPENSATION IS DETERMINED FOR THESE INDIVIDUALS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. PLANNED PARENTHOOD MAR MONTE INC 1691 THE ALAMEDA SAN JOSE CA 95126 941583439 TO PROVIDE HEALTH CARE AND EDUCATION, AND EXPAND RIGHTS AND ACCESS FOR ALL CA 501(C)(3) LINE 7 N/A 0 PLANNED PARENTHOOD ADVOCATES MAR MONTE INC 1691 THE ALAMEDA SAN JOSE CA 95126 770261817 ADVOCACY, EDUCATION, AND POLITICAL SUPPORT FOR REPRODUCTIVE HEALTH CARE CA 501(C)(4) PLANNED PARENTHOOD MAR MONTE INC 0 WE VOTE - NOSOTROS VOTAMOS POLITICAL ACTION COMMITTEE 1691 THE ALAMEDA SAN JOSE CA 95126 460772665 TO ELECT OFFICIALS ADVOCATING FOR ACCESS TO QUALITY REPRODUCTIVE HEALTH CARE CA 527 PPAMM 0 0 0 0 1 1 0 0 0 0 0 0 1 1 0 1 1 1 0 0