2021-06-22T09:58:40-05:00 2020-06-30 410746749 CLIFTONLARSONALLEN LLP 20 E THOMAS RD STE 2300 PHOENIX AZ 85012 990 2019-07-01 953881333 CLINICA MSR OSCAR A ROMERO CLIN 2132012606 2032 MARENGO STREET LOS ANGELES CA 90033 CARLOS A VAQUERANO EXECUTIVE DIRECTOR 2132012606 2021-06-21 1 KURT BENNION P01469618 6022662248 2021-06-21 2019 2022-09-23 18:48:47Z CARLOS A VAQUERANO 2032 MARENGO STREET LOS ANGELES CA 90033 15219527 0 X WWW.CLINICAROMERO.COM X 1983 CA PROVIDE QUALITY, AFFORDABLE AND CULTURALLY SENSITIVE HEALTH CARE AND OTHER SERVICES TO THE UNINSURED, INSURED AND UNDERSERVED COMMUNITIES OF GREATER LOS ANGELES. 11 11 183 44 0 0 5382383 6933835 8986309 7997850 1317 580 191754 273020 14561763 15205285 11410 0 0 0 9553703 9706346 0 131490 152334 5526083 4445577 15091196 14283413 -529433 921872 8071626 7366321 6206402 4579225 1865224 2787096 X OUR MISSION IS TO PROVIDE QUALITY, AFFORDABLE AND CULTURALLY SENSITIVE HEALTH CARE AND OTHER SERVICES TO THE UNINSURED, INSURED AND UNDERSERVED COMMUNITIES OF GREATER LOS ANGELES REGARDLESS OF THEIR ABILITY TO PAY BY UPHOLDING THE LEGACY AND (CONTINUED IN SCHEDULE O) TRADITION OF MONSENOR OSCAR A. ROMERO AND EDUCATING AND EMPOWERING SALVADORAN AND OTHER COMMUNITY MEMBERS THROUGH COMMUNITY ORGANIZING, HEALTH EDUCATION AND SOCIAL JUSTICE AND EXCHANGE PROGRAMS IN EL SALVADOR. 0 0 10073499 0 4773505 CLINICA ROMERO PROVIDES LOW-COST COMPREHENSIVE PRIMARY CARE AND DISEASE PREVENTION SERVICES FOR MEN, WOMEN AND CHILDREN OF ALL AGES. OUR DOCTORS STRIVE TO PROVIDE THE BEST LEVEL OF CARE IN ORDER TO IMPROVE THE QUALITY OF LIFE OF ALL PATIENTS. SERVICES INCLUDE: EXAMS: COMPLETE MEDICAL EXAMINATIONSCANCER SCREENINGS: LAB TESTS, ULTRASOUNDSCHRONIC DISEASE MANAGEMENT: MEDICATIONS AND LIFESTYLE REGIMENS FOR AVOIDING COMPLICATIONS ASSOCIATED WITHASTHMA, HEART DISEASE, HYPERTENSION, HIGH BLOOD PRESSURE AND DIABETESFAMILY PLANNING: PROGRAMS TO ASSIST YOUNG AND BEGINNING FAMILIES(CONTINUED IN SCHEDULE O)PRENATAL CARE: PRENATAL CLASSES AND NUTRITIONAL GUIDANCEPEDIATRICS: WELL-CHILD VISITS FOR HEALTHY GROWTH AND DEVELOPMENTVACCINATIONS: PEDIATRIC IMMUNIZATIONS AND ADULT VACCINESWE PROVIDE MEDICAL, DENTAL, MENTAL HEALTH, AND SUBSTANCE USE DISORDER TO HOMELESS POPULATION. WE ALSO PROVIDE MOBILE SHOWER AND DISTRIBUTE HYGIENE PRODUCTS, CLOTHES AND FOOD TO THE POPULATION. 1296761 0 1184551 CLINICA ROMERO PROVIDES A LOW-COST DENTAL SERVICES FOR ADULTS AND CHILDREN IN A FRIENDLY ENVIRONMENT THAT PUTS OUR PATIENTS AT EASE. GOOD ORAL HEALTH REQUIRES REGULAR DENTAL EXAMINATION AND MAINTENANCE TO HELP PREVENT AND MANAGE DISEASE. OUR TEAM SPECIALIZES IN PREVENTATIVE CARE AND PROVIDES THE FOLLOWING SERVICES: SERVICES FOR ADULTS: COMPLETE ORAL EXAMINATIONS INCLUDING X-RAYSPREVENTATIVE SERVICES AND PERIODIC PERIODONTAL MAINTENANCE TREATMENT: PROPHYLAXIS (CLEANINGS) AND NON-SURGICAL PERIODONTAL TREATMENT (SCALING AND ROOT PLANING), ORAL HYGIENE EDUCATION (CONTINUED IN SCHEDULE O)RESTORATIVE SERVICES: RESTORATION FILLINGS, CANAL TREATMENT LIMITED TO ANTERIOR TEETH, SIMPLE EXTRACTIONS SERVICES FOR CHILDREN: COMPLETE ORAL EXAMINATIONS AND X-RAYS PREVENTATIVE SERVICES: PROPHYLAXIS (CLEANINGS), FLUORIDE VARNISH APPLICATIONS, SEALANTS, ORAL HYGIENE EDUCATIONRESTORATIVE SERVICES: RESTORATION FILLINGS, PULPOTOMIES, STAINLESS STEEL CROWNS, SPACE MAINTAINERS, SIMPLE EXTRACTIONS 438491 0 2039794 CLINICA IS COMMITTED TO PROVIDING PRESCRIPTION MEDICATION THAT FITS WITHIN A PATIENT'S BUDGET. OUR PHARMACEUTICAL STAFF IS COMMITTED TO PROVIDING ACCURATE AND EASY TO UNDERSTAND INFORMATION REGARDING THE MEDICATION PRESCRIBED TO OUR PATIENTS. SERVICES INCLUDE: ON-SITE FILLING OF PRESCRIPTIONSPRESCRIPTION REFILLSMEDICATION MANAGEMENT IN COORDINATION WITH PRIMARY CARE PHYSICIAN 11808751 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 184 0 183 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 0 0 1 1 0 CA X VANIA BOYADJIAN 2132012734 2032 MARENGO STREET LOS ANGELES CA 90033 DR RODNEY SAMAAN MEDICAL DIRECTOR (THROUGH OCT 2019) 40.00 X 251629 0 4253 CARLOS VAQUERANO EXECUTIVE DIRECTOR 40.00 X 200000 0 35087 DR FERNANDO RODRIGUEZ DDS DENTAL DIRECTOR 40.00 X 143343 0 16966 JAMEY COREY PHARMACY DIRECTOR 32.00 X 132310 0 22138 DEISY MENDOZA PHYSICIAN ASSISTANT 40.00 X 137678 0 14779 MARIA MARZAN DENTIST 32.00 X 124208 0 16371 ISABEL CORTEZ REV CYCLE DIR, BUSINESS DEVELOPMENT 40.00 X 117087 0 22287 DON GARCIA MEDICAL DIRECTOR 40.00 X 126252 0 4952 GUISELA JUAREZ OPERATIONS DIRECTOR 40.00 X 100096 0 23287 VANIA BOYADJIAN FINANCE DIRECTOR 40.00 X 110769 0 8541 MARCELO VILLAGOMEZ PRESIDENT 1.00 X X 0 0 0 DOUGLAS CARRAZA VICE PRESIDENT 1.00 X X 0 0 0 PADRE ALFREDO PALACIOS SECRETARY 1.00 X X 0 0 0 DR SONIA MOLINA TREASURER 1.00 X X 0 0 0 ARMANDO CARRANZA MEMBER 1.00 X 0 0 0 MARIN CASTILLO MEMBER 1.00 X 0 0 0 SANTOS ROMINA FERNANDEZ DE BUDDE, MEMBER 1.00 X 0 0 0 MARIO HERCULES MEMBER 1.00 X 0 0 0 SANDRA RODRIGUEZ MEMBER 1.00 X 0 0 0 JOSE LINO RUIZ MEMBER 1.00 X 0 0 0 MARITZA ZAMBRANO MEMBER 1.00 X 0 0 0 1443372 0 168661 18 0 1 0 QUEST DIAGNOSTIC PO BOX 912411 PASADENA CA 91110 LABORATORY SERVICES 358958 KPG HEALTH CARE LLC PO BOX 840202 LOS ANGELES CA 90084 MEDICAL SERVICES 337520 FUNES SECURITY 1241 S SOTO STREET LOS ANGELES CA 90023 SECURITY SERVICES 244478 7 LAYER IT SOLUTIONS INC 17701 CHATSWORTH ST GRANADA HILLS CA 91344 IT SERVICES 208700 OCHIN 1881 SW NAITO PKWY PORTLAND OR 97201 EMR SERVICES 195659 8 6920674 13161 6933835 MEDICAL SERVICES 621110 5958056 5958056 PHARMACY 621110 2039794 2039794 7997850 580 580 4349 14242 -9893 -9893 -9893 OTHER INCOME 900099 282913 282913 282913 15205285 7997850 0 273600 873246 150898 722348 6840827 6128644 712183 85269 71481 13788 1293734 1143030 150704 613270 514107 99163 23659 23659 72361 72361 131490 131490 497216 431226 52830 13160 42821 18181 24424 216 285814 217716 64153 3945 258702 251747 6955 436071 358432 76034 1605 10464 4443 5968 53 23023 9775 13132 116 146257 62099 83421 737 508316 436962 71354 82110 34863 46833 414 MEDICAL SUPPLIES 1175952 1175952 PROGRAM EXPENSES 666327 648412 17915 MISCELLANEOUS 96506 40976 55044 486 DUES AND SUBSCRIPTIONS 78557 72019 6538 41421 37788 3521 112 14283413 11808751 2322328 152334 1030359 1013546 715381 639323 1091927 573015 60381 45857 37388 47998 9120055 4073473 5136190 5046582 8071626 7366321 2227595 740695 2726 519797 3976081 3308733 10000 6206402 4579225 X 1252105 1784988 613119 1002108 1865224 2787096 8071626 7366321 921872 0 X 0 1 X 1 1 1 X 3846918 4066782 5142967 5382383 6933835 25372885 3846918 4066782 5142967 5382383 6933835 25372885 25372885 74849 5465 1500 7490 4929 94233 409907 1236918 654570 200727 282913 2785035 28252153 41982411 0.89810 0.87910 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1618324 1618324 3941517 2532290 1409227 1788210 176616 1611594 1764259 1364567 399692 7745 7745 5046582 X 15219527 14242 14242 15205285 0 15205285 14297655 14242 14242 14283413 0 14283413 PART X, LINE 2: CLINICA IS A NONPROFIT CORPORATION, EXEMPT FROM THE PAYMENT OF INCOME TAXES UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3) AND CALIFORNIA REVENUE AND TAXATION CODE SECTION 23701(D). ACCORDINGLY, NO PROVISION HAS BEEN MADE FOR INCOME TAXES. HOWEVER, CLINICA IS SUBJECT TO INCOME TAXES ON ANY NET INCOME THAT IS DERIVED FROM A TRADE OR BUSINESS NOT IN FURTHERANCE OF THE PURPOSES FOR WHICH IT WAS GRANTED EXEMPTION. NO INCOME TAX PROVISION HAS BEEN RECORDED AS THE NET INCOME, IF ANY, FROM ANY UNRELATED TRADE OR BUSINESS IN THE OPINION OF MANAGEMENT, IS NOT MATERIAL TO THE FINANCIAL STATEMENTS TAKEN AS A WHOLE. CLINICA FOLLOWS THE GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE APPLICATION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. CLINICA'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 14,242. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 14,242. X X 0 ESTRA DARLEY MILLER GROUP 2581 AREVIA STREET 12 LOS ANGELES CA 90065 GRANT WRITING, PAYPAL FUNDRAISING 0 1700000 70490 1629510 BOODLE ADVISORS LLC 4247 CAMELLIA AVENUE STUDIO CITY CA 91604 FUNDRAISING & STRATEGIC ALLIANCE/PARTNERSHIP SUPPORT 0 1000000 61000 939000 2700000 131490 2568510 CA X 0 0 0 0 0 0 0 0 0 DR RODNEY SAMAAN MEDICAL DIRECTOR (THROUGH OCT 2019) 251629 0 0 0 0 0 0 0 4253 0 255882 0 0 0 CARLOS VAQUERANO EXECUTIVE DIRECTOR 200000 0 0 0 0 0 0 0 35087 0 235087 0 0 0 DR FERNANDO RODRIGUEZ DDS DENTAL DIRECTOR 143343 0 0 0 0 0 0 0 16966 0 160309 0 0 0 JAMEY COREY PHARMACY DIRECTOR 132310 0 0 0 0 0 0 0 22138 0 154448 0 0 0 DEISY MENDOZA PHYSICIAN ASSISTANT 137678 0 0 0 0 0 0 0 14779 0 152457 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS AND IMMEDIATE PAST PRESIDENT OF THE BOARD OF DIRECTORS. THE EXECUTIVE DIRECTOR AND OTHER NON-DIRECTORS MAY BE DESIGNATED AS NON-VOTING ADVISORS TO THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE (A) EXERCISES SUCH AUTHORITY AS IS DELEGATED TO IT BY THE BOARD OF DIRECTORS AND CAN ACT IN THE BOARD'S ABSENCE DURING AN EMERGENCY IF THE FULL BOARD IS UNABLE TO MEET, (B) HAS OVERSIGHT OVER STRATEGIC PLANNING FOR THE ORGANIZATION, AND (C) WORKS WITH THE EXECUTIVE DIRECTOR AND DEVELOPMENT DEPARTMENT TO OBTAIN FUNDS FROM A BROAD RANGE OF SOURCES IN BOTH THE PUBLIC AND PRIVATE SECTOR. FORM 990, PART VI, SECTION B, LINE 11B CLINICA MSR OSCAR A ROMERO'S OUTSIDE AUDITORS AND FINANCIAL STAFF PREPARED THE FORM 990. THE FORM WAS THEN REVIEWED BY THE FINANCE DIRECTOR AND THE EXECUTIVE DIRECTOR, THEN BY THE FINANCE COMMITTEE, THEN BY THE FULL BOARD OF DIRECTORS BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CLINICA MSR OSCAR A ROMERO (CMOAR) REQUIRES ALL EMPLOYEES TO DISCLOSE, AT LEAST ANNUALLY, ALL SOURCES OF INCOME FROM COMPENSATION OR FROM OWNERSHIP OF EVERY OUTSIDE ENTITY THAT (A) SOLD, SUPPLIED OR PROVIDED SERVICES (B) OPERATED A COMPETING ENTERPRISE OR (C) PROVIDED GOODS OR SERVICES TO CMOAR IN THE LAST SIX MONTHS. CMOAR ALSO REQUIRES ALL DIRECTORS TO ANNUALLY SIGN A STATEMENT AFFIRMING (A) RECEIPT OF CMOAR CONFLICT OF INTEREST POLICY (B) UNDERSTANDING OF THE POLICY AND (C) AGREEMENT WITH THE POLICY. CMOAR CONFLICT OF INTEREST POLICY DESCRIBES HOW CMOAR WILL RESOLVE POSSIBLE CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD REVIEWED ALL OF THE OFFICERS' COMPENSATION, INCLUDING THAT OF THE EXECUTIVE DIRECTOR. THE BOARD REVIEWED DATA OF COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED NONPROFIT EXECUTIVES. THE OCCURRENCE OF THESE DELIBERATIONS ARE NOTED IN THE BOARD MINUTES. THIS PROCESS LAST OCCURRED IN 2019. FORM 990, PART VI, SECTION C, LINE 18 IN ADDITION TO BEING AVAILABLE UPON REQUEST, THE ORGANIZATION'S FORM 990 IS AVAILABLE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.