2024-05-10T11:43:55-05:00 2023-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2022-07-01 831342199 LA CLINICA VALLEJO GEORGIA STREET PROPERTY OWNER 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 230460 0 X WWW.LACLINICA.ORG X 2018 CA TO SUPPORT LA CLINICA THROUGH FINANCING THE CONSTRUCTION OF A HEALTH CARE FACILITY IN VALLEJO, CA. 16 16 0 16 0 0 1232926 0 230004 230004 247 456 0 0 1463177 230460 0 0 0 0 0 0 0 0 0 773125 807340 773125 807340 690052 -576880 24584477 24059914 17007654 17059971 7576823 6999943 X THE CORPORATION IS ORGANIZED FOR THE PURPOSE OF SUPPORTING THE CHARITABLE ACTIVITIES OF LA CLINICA DE LA RAZA, INC., A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION, INCLUDING LA CLINICA DE LA RAZA'S PROPOSED HEALTH CLINIC IN SOLANO COUNTY, CALIFORNIA AND SERVING AS A QUALIFIED ACTIVE LOW-INCOME COMMUNITY BUSINESS, AS SUCH TERM IS DEFINED IN SECTION 45D OF THE INTERNAL REVENUE CODE. 0 0 783599 0 230004 THE ORGANIZATION SUPPORTS THE CHARITABLE ACTIVITIES OF LA CLINICA DE LA RAZA ("SUPPORTED ORGANIZATION") BY FINANCING THE CONSTRUCTION OF, AND LEASING TO ITS SUPPORTED ORGANIZATION, A 26,000 SQUARE FOOT TWO-STORY MODERN, STATE-OF-THE-ART INTEGRATED HEALTH CARE FACILITY IN DOWNTOWN VALLEJO. 783599 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 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 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 16 16 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X KANWAR SINGH 5105352915 1450 FRUITVALE AVENUE THIRD FLOOR OAKLAND CA 94601 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 ALVARO FUENTES INDEPENDENT DIRECTOR 1.00 0.00 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 JANE GARCIA CHIEF EXECUTIVE OFFICER 1.00 40.00 X 0 624588 84839 SUSAN MOORE CFO (THROUGH 11/2022) 1.00 40.00 X 0 196637 19528 KANWAR SINGH CFO (START 10/2022) 1.00 40.00 X 0 39472 9897 0 860697 114264 0 0 1 0 2 RENTAL INCOME 531120 230004 230004 230004 456 456 230460 230004 0 456 175500 175500 599342 599342 AMORT OF ISSUANCE COSTS 21017 8757 12260 BORROWER FEES 11481 11481 807340 783599 23741 0 2224 0 383052 458266 24800333 1198685 24199201 23601648 24584477 24059914 14625 26758 0 19167 16993029 17014046 17007654 17059971 X -256325 -833205 7833148 7833148 7576823 6999943 24584477 24059914 -576880 0 X 0 1 X 1 0 X X 1 LA CLINICA DE LA RAZA INC 941744108 7 1 0 230004 1 0 230004 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 SCHEDULE A, PART I, LINE 12G, COLUMN (VI): LA CLINICA VALLEJO GEORGIA STREET PROPERTY OWNER WAS ORGANIZED FOR THE PURPOSE OF SUPPORTING THE CHARITABLE ACTIVITIES OF LA CLINICA DE LA RAZA, INC. ("SUPPORTED ORGANIZATION"); IN PARTICULAR, THE ORGANIZATION HOLDS TITLE TO, AND LEASES TO ITS SUPPORTED ORGANIZATION, A 26,000 SQUARE FOOT, TWO-STORY MODERN STATE-OF-THE-ART INTEGRATED HEALTH CARE FACILITY IN DOWNTOWN VALLEJO, CA. 819845 819845 23973693 1198685 22775008 6795 6795 23601648 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. 0 1 0 0 0 0 0 0 0 JANE GARCIA CHIEF EXECUTIVE OFFICER 0 405484 0 50300 0 168804 0 65682 0 19157 0 709427 0 86477 SUSAN MOORE CFO (THROUGH 11/2022) 0 194837 0 800 0 1000 0 2058 0 17470 0 216165 0 0 PART I, LINE 3 THE ORGANIZATION'S CEO IS COMPENSATED BY LA CLINICA DA LA RAZA, INC., A RELATED ORGANIZATION. LA CLINICA DE LA RAZA, INC. UTILIZED THE FOLLOWING METHODS TO DETERMINE THE CEO'S COMPENSATION: COMPENSATION SURVEY OR STUDY; APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B JANE GARCIA PARTICIPATES IN A SUPPLEMENTAL, NONQUALIFIED 457(F) RETIREMENT PLAN PROVIDED THROUGH LA CLINICA DE LA RAZA, INC., A RELATED 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). FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION DOES NOT HAVE "MEMBERS" BY DEFINITION OF THE BYLAWS; HOWEVER, THE FORM 990 INSTRUCTIONS ALSO DEFINE A "MEMBER" AS ANY PERSON (INCLUDING A CORPORATION OR OTHER LEGAL ENTITY) WHO, PURSUANT TO A PROVISION OF THE ORGANIZATION'S GOVERNING DOCUMENTS, HAS THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE (INCLUDING ELECTING MEMBERS OF THE GOVERNING BODY). ACCORDINGLY, THE ORGANIZATION HAS ONE SOLE MEMBER: LA CLINICA DE LA RAZA, INC., A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A ALL MEMBERS OF THE BOARD OF DIRECTORS, EXCEPT FOR THE INDEPENDENT DIRECTOR, SHALL BE SELECTED BY LA CLINICA DE LA RAZA, INC. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF DIRECTORS OF LA CLINICA DE LA RAZA, INC. HAS THE POWER TO APPOINT THE CHIEF EXECUTIVE OFFICER OF LA CLINICA VALLEJO GEORGIA STREET PROPERTY OWNER. ADDITIONALLY, LA CLINICA VALLEJO GEORGIA STREET PROPERTY OWNER MAY NOT BE DISSOLVED WITHOUT THE WRITTEN APPROVAL OF LA CLINICA DE LA RAZA, INC. 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 EACH OFFICER, KEY EMPLOYEE, AND MEMBER OF THE BOARD OF DIRECTORS ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: (I) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; (II) HAS READ AND UNDERSTANDS THE POLICY; AND (III) HAS AGREED TO COMPLY WITH THE POLICY. SHOULD A POTENTIAL CONFLICT OF INTEREST ARISE, THE BOARD OF DIRECTORS (OR A COMMITTEE OF THE BOARD OF DIRECTORS WITH DELEGATED POWERS) SHALL MEET TO DETERMINE WHETHER A CONFLICT OF INTEREST ACTUALLY EXISTS. THE INTERESTED PERSON MAY APPEAR AT THE BOARD OR COMMITTEE MEETING FOR THE SOLE PURPOSE OF ANSWERING QUESTIONS. AFTER ANY SUCH QUESTIONS ARE ANSWERED, THE INTERESTED PERSON SHALL LEAVE THE MEETING WHILE THE DETERMINATION OF WHETHER A CONFLICT OF INTEREST EXISTS IS DISCUSSED AND VOTED UPON. TO ADDRESS ACTUAL CONFLICTS OF INTEREST, THE CHAIRPERSON OF THE BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE BOARD OR COMMITTEE DETERMINES WHETHER THE CORPORATION CAN OBTAIN, WITH REASONABLE EFFORT, A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. THE DELIBERATION AND DECISION-MAKING PROCESS IS RECORDED IN THE BOARD (OR COMMITTEE) MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION DOES NOT COMPENSATE ANY OFFICERS OR KEY EMPLOYEES; RATHER, THESE INDIVIDUALS ARE COMPENSATED BY LA CLINICA DE LA RAZA, INC., A RELATED ORGANIZATION. ACCORDINGLY, FORM 990, PART VI, SECTION B, LINES 15A AND 15B HAVE BEEN ANSWERED "NO" AS MANDATED BY THE FORM 990 INSTRUCTIONS. FORM 990, PART VI, SECTION C, LINE 19 THE AUDITED FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND THE CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. LA CLINICA DE LA RAZA INC PO BOX 22210 OAKLAND CA 946232210 941744108 FEDERALLY QUALIFIED HEALTH CENTER CA 501(C)(3) LINE 7 N/A 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 LA CLINICA DE LA RAZA INC J 230004 BOOK VALUE