2020-07-13T22:30:23-05:00 2019-06-30 410746749 CLIFTONLARSONALLEN LLP 20 E THOMAS RD STE 2300 PHOENIX AZ 85012 990 2018-07-01 953881333 CLINICA MSR OSCAR A ROMERO CLIN 2132012606 2032 MARENGO STREET LOS ANGELES CA 90033 CARLOS A VAQUERANO EXECUTIVE DIRECTOR 2132012606 2020-07-11 1 KURT BENNION P01469618 6022662248 2020-07-11 67.137.57.251 2020-07-11 19:24:43 PD P 6090138281F26C81E44F33703B5A75F6ECDC86D4 6DFCD1967819CE616E4FF511662B8C57821E54A4 2018 2021-01-29 14:40:06Z CARLOS A VAQUERANO 2032 MARENGO STREET LOS ANGELES CA 90033 14576909 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 11 194 100 0 0 5244748 5382383 8451137 8986309 502 1317 637933 191754 14334320 14561763 17536 11410 0 0 9593090 9553703 0 0 146729 4996120 5526083 14606746 15091196 -272426 -529433 7552947 8071626 5105147 6206402 2447800 1865224 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 10306370 11410 5375384 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 EXAMINATIONS.CANCER SCREENINGS: LAB TESTS, ULTRASOUNDS.CHRONIC DISEASE MANAGEMENT: MEDICATIONS AND LIFESTYLE REGIMENS FOR AVOIDING COMPLICATIONS ASSOCIATED WITH ASTHMA, HEART DISEASE, HYPERTENSION, HIGH BLOOD PRESSURE AND DIABETES.FAMILY PLANNING: PROGRAMS TO ASSIST YOUNG AND BEGINNING FAMILIES.(CONTINUED IN SCHEDULE O)PRENATAL CARE: PRENATAL CLASSES AND NUTRITIONAL GUIDANCE.PEDIATRICS: WELL-CHILD VISITS FOR HEALTHY GROWTH AND DEVELOPMENT.VACCINATIONS: PEDIATRIC IMMUNIZATIONS AND ADULT VACCINES. 1621040 0 1361267 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-RAYS.PREVENTATIVE 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 EXTRACTIONSSERVICES FOR CHILDREN:COMPLETE ORAL EXAMINATIONS AND X-RAYSPREVENTATIVE SERVICES:PROPHYLAXIS (CLEANINGS), FLUORIDE VARNISH APPLICATIONS, SEALANTS, ORAL HYGIENE EDUCATIONRESTORATIVE SERVICES:RESTORATION FILLINGS, PULPOTOMIES, STAINLESS STEEL CROWNS, SPACE MAINTAINERS, SIMPLE EXTRACTIONS 440979 0 2249658 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 PRESCRIPTIONS.PRESCRIPTION REFILLS.MEDICATION MANAGEMENT IN COORDINATION WITH PRIMARY CARE PHYSICIAN. 0 0 0 CLINICA PROVIDES CULTURALLY COMPETENT COMPREHENSIVE BEHAVIORAL HEALTH SERVICES TO MOST PEOPLE AT EVERY STAGE OF LIFE FROM ELEMENTARY SCHOOL CHILDREN TO SENIORS. OUR COMPREHENSIVE BEHAVIORAL HEALTH SERVICES ARE AVAILABLE AT BOTH OF OUR FACILITIES WHERE PATIENTS ARE OFFERED DAYS AND EVENING HOURS. SERVICES INCLUDE: INDIVIDUAL, COUPLES, FAMILY AND GROUP THERAPY, ADDRESSING ISSUES SUCH AS ANXIETY AND STRESS, DEPRESSION, PARENT-CHILD RELATIONSHIP, SEXUAL AND PHYSICAL ABUSE, GUILT, LONELINESS, POOR COMMUNICATION, LOSS OF TRUST, RESENTMENT. THE DEPARTMENT ALSO PROVIDES PREVENTIVE MENTAL HEALTH SERVICES FOLLOWING THE STRESS MANAGEMENT AND TRAUMA FOCUS MODEL. CASE MANAGEMENT - OUR BILINGUAL BEHAVIORAL HEALTH SPECIALISTS ARE AVAILABLE TO ASSESS PATIENT'S NEEDS AND TO LINK THEM WITH AVAILABLE COMMUNITY RESOURCES. 0 0 0 SUBSTANCE USE DISORDER PROGRAM ACCOMPLISHMENTS: CLINICA WAS ABLE TO ROLL OUT OUR MEDICATION ASSISTED TREATMENT ("MAT") PROGRAM AND START SEEING MAT PATIENTS ON AN OUTPATIENT BASIS WHO STRUGGLE WITH OPIOID/HEROIN ADDICTION. CLINICA WAS ABLE GET STATE APPROVAL FOR OUR NEW SUD SITE AT 123 SOUTH ALVARADO IN THE PICO UNION AREA WHERE WE WILL BE ABLE TO PROVIDE OUTPATIENT AND INTENSIVE OUTPATIENT SERVICES TO A COMMUNITY IN NEED OF THESE SERVICES. CLINICA CREATED NEW JOB DESCRIPTIONS TO INSURE WE CAN CONTINUE TO GROW AND OFFER QUALITY PROFESSIONAL SUD SERVICES. 0 0 0 12368389 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 68 0 194 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 1 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 SANDRA ROSSATO PRESIDENT (THROUGH SEPTEMBER 2018) 40.00 X X 0 0 0 MARCELO VILLAGOMEZ TREASURER & PRESIDENT 1.00 X X 0 0 0 RAFAEL SWEET ESQ VICE PRESIDENT (THROUGH JULY 2018) 1.00 X X 0 0 0 DOUGLAS CARRAZA VICE PRESIDENT 1.00 X X 0 0 0 KRYSSIA CAMPOS SECRETARY (THROUGH MAY 2019) 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 LORENA BERNARDO MEMBER (THROUGH AUGUST 2018) 1.00 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 KEITH MARTIN MSW MEMBER (THROUGH NOVEMBER 2018) 1.00 X 0 0 0 YAMILET MARISOL MONCADA MEMBER (THROUGH OCTOBER 2018) 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 ADALY UGALDE MEMBER (THROUGH OCTOBER 2018) 1.00 X 0 0 0 MARITZA ZAMBRANO MEMBER 1.00 X 0 0 0 CARLOS VAQUERANO INTERIM EXEC DIR & EXEC DIR 40.00 X 126633 0 4900 KEN STEWART CONTRACT FINANCE DIRECTOR (THROUGH JANUARY 2019) 24.00 X 0 0 0 VANIA BOYADJIAN FINANCE DIRECTOR (AS OF JANUARY 2019) 40.00 X 0 0 0 JACKIE PROVOST CONTRACT OPERATIONS DIR (THROUGH JUNE 2019) 24.00 X 0 0 0 GUISELA JUAREZ OPERATIONS DIR (AS OF JUNE 2019) 40.00 X 0 0 0 DR SAMUEL PIERCE MEDICAL DIRECTOR (THROUGH JULY 2018) 40.00 X 128469 0 0 DR RODNEY SAMAAN ASSOCIATE MEDICAL DIRECTOR & MEDICAL DIRECTOR 32.00 X 161902 0 0 DR FERNANDO RODRIGUEZ DDS DENTAL DIRECTOR 40.00 X 139846 0 0 DEISY MENDOZA PHYSICIAN ASSISTANT 40.00 X 134274 0 0 JAMEY COREY PHARMACY DIRECTOR 32.00 X 133397 0 0 MARIA MARZAN DENTIST 32.00 X 113554 0 0 ISABEL CORTEZ REVENUE CYCLE DIRECTOR, BUSINESS DEVELOPMENT 40.00 X 118151 0 0 1056226 0 4900 11 0 1 0 7 LAYER IT SOLUTIONS INC 17701 CHATSWORTH ST GRANADA HILLS CA 91344 IT SERVICES 511194 OCHIN 1881 SW NAITO PKWY PORTLAND OR 97201 EMR SERVICES 295679 FUNES SECURITY 1241 S SOTO STREET LOS ANGELES CA 90023 SECURITY SERVICES 191193 MARY ROMO 5101 E FLORENCE 5 BELL CA 90201 OBGYN 141186 ALACE BENTON 19961 ROTHER LN HUNTINGTON BEACH CA 92646 PSYCHOLOGIST 112039 6 5237795 144588 5382383 MEDICAL SERVICES 621110 6736651 6736651 PHARMACY 621110 2249658 2249658 8986309 1317 1317 6173 15146 -8973 -8973 -8973 OTHER INCOME 900099 200727 200727 200727 14561763 8986309 0 193071 11410 11410 602360 96278 506082 6840704 6037370 800432 2902 1516843 1319107 196463 1273 593796 513139 80162 495 19569 19569 118409 118409 1069870 683847 250318 135705 69583 42049 27253 281 116002 60583 55419 314051 310550 3501 537140 469478 65584 2078 16494 9967 6460 67 37686 22774 14760 152 106037 64078 41530 429 521508 433676 87298 534 86345 52178 33818 349 PROGRAM EXPENSES 1796454 1776303 20151 MISCELLANEOUS 560223 338540 219415 2268 MAINTENANCE AND REPAIRS 98342 68692 29454 196 DUES AND SUBSCRIPTIONS 58370 58370 15091196 12368389 2576078 146729 1045388 1030359 382665 715381 1440599 1091927 62592 60381 27100 37388 8701347 3565157 4594603 5136190 7552947 8071626 1026693 2227595 2726 2726 4075728 3976081 5105147 6206402 X 2053136 1252105 394664 613119 2447800 1865224 7552947 8071626 -529433 -53143 0 X 0 1 X 1 1 1 X 3619153 3846918 4066782 5142967 5382383 22058203 3619153 3846918 4066782 5142967 5382383 22058203 22058203 62547 74849 5465 1500 7490 151851 378315 409907 1236918 654570 200727 2880437 25090491 41223198 0.87910 0.86280 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME MEANINGFUL USE REVENUE RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1618324 1618324 3941517 2379112 1562405 1563443 236271 1327172 1578063 949774 628289 5136190 X 14576909 15146 15146 14561763 0 14561763 15106342 15146 15146 15091196 0 15091196 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 15,146. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 15,146. 1 PART I, LINE 2: AMOUNTS GIVEN WERE SPONSORSHIPS FOR LOCAL CHARITIES. ALL AMOUNTS GIVEN WERE INTENDED FOR GENERAL OPERATING SUPPORT AND NO MONITORING OCCURRED SUBSEQUENT TO THE EVENT. X 0 0 0 0 0 0 0 1 0 DR RODNEY SAMAAN ASSOCIATE MEDICAL DIRECTOR & MEDICAL DIRECTOR 158402 0 3500 0 0 0 0 0 0 0 161902 0 0 0 PART I, LINE 7 DURING 2018, PROVIDERS RECEIVED BONUSES THAT WERE DETERMINED BY THE EXECUTIVE DIRECTOR AND REVIEWED BY THE BOARD OF DIRECTORS. 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 A, LINE 3 DURING THE FISCAL YEAR, THE ORGANIZATION CONTRACTED WITH COMMUNITY LINK CONSULTING FOR FINANCIAL MANAGEMENT SERVICES AND GREG FACTOR & ASSOCIATES FOR OPERATIONAL MANAGEMENT SERVICES. 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 DELIBERATION 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.