2017-05-15T15:58:54-05:00 2016-06-30 946214841 ARMANINO LLP 12657 ALCOSTA BLVD STE 500 SAN RAMON CA 945834600 990 2015-07-01 237118361 TIBURCIO VASQUEZ HEALTH CENTER INC TIBU 5104715880 22331 MISSION BLVD HAYWARD CA 945413911 DAVID B VLIET CEO 5104715880 2017-05-15 1 KATY BROWN P00650274 9257902600 2015 2021-01-29 14:40:06Z DAVID B VLIET 22331 MISSION BLVD HAYWARD CA 945413911 28044389 0 X WWW.TVHC.ORG X 1971 CA TIBURCIO VASQUEZ HEALTH CENTER, INC. IS A PRIVATE NONPROFIT ORGANIZATION FORMED TO SPONSOR, PROMOTE, AND PROVIDE COMPREHENSIVE COMMUNITY HEALTH SERVICES THAT APPROPRIATELY MEET THE PHYSICAL, MENTAL, AND SOCIAL NEEDS OF SOUTHERN ALAMEDA COUNTY. 10 10 327 17 0 0 10576830 10452791 13436427 17059907 71526 71145 504113 426638 24588896 28010481 0 750 0 0 16352018 18345722 0 0 0 7796333 7938698 24148351 26285170 440545 1725311 15360001 17761719 9730401 10406808 5629600 7354911 PROVIDE COMPREHENSIVE COMMUNITY HEALTH SERVICES TO SOUTHERN ALAMEDA COUNTY. 0 0 3125669 750 3124919 HEALTHPAC: PROVIDES MEDICALLY NECESSARY SERVICES TO LOW-INCOME UNINSURED INDIVIDUALS ENROLLED IN THE COUNTY MEDICALLY INDIGENT SERVICES PLAN. 1768000 1768000 PRIMARY CARE OUTPATIENT: THE MEDICAL CLINIC PROVIDES BASIC HEALTH CARE FOR THE PEOPLE OF ALL AGES FAMILY MEDICINE, INTERNAL MEDICINE, PEDIATRICS AND OBSTETRICS-GYNOCOLOGY. THE DENTAL DEPARTMENT OFFERS A VARIETY OF DENTAL CARE FOR CHILDREN AND ADULTS, INCLUDING DENTAL EXAMS, FILLINGS, CROWNS, ROOT CANALS, EXTRACTIONS, SPACE MAINTAINERS, AND EMERGENCY SERVICES. 1566065 1565963 EPSDT: PROVIDES MENTAL HEALTH SERVICES, CASE MANAGEMENT, CRISIS INTERVENTION, AND MEDICATION SUPPORT SERVICES TO TEEN PARENTS, ADULT PARENTS AND THEIR CHILDREN. 15369556 10601025 15369556 10601025 21829290 1 1 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 59 0 1 327 1 0 0 0 0 0 0 0 0 0 0 X 10 10 1 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 CA X BRENT COPEN 5104715880 22331 MISSION BLVD HAYWARD CA 945413911 NANCY SOTO PRESIDENT 3.00 X X 0 0 0 MINYON CORCUCHIA-GARDE VICE PRESIDENT 1.50 X X 0 0 0 JAIME PATINO 2ND VICE PRESIDENT 1.50 X X 0 0 0 JESSE ROBLES TREASURER 1.50 X X 0 0 0 JOSUE A HERNANDEZ SECRETARY 1.50 X X 0 0 0 AHMAD ASIR BOARD MEMBER 1.50 X 0 0 0 CARLA RAMIREZ BOARD MEMBER 1.50 X 0 0 0 MARIA SABADO BOARD MEMBER 1.50 X 0 0 0 CHRISTIAN STOCKWELL BOARD MEMBER 1.50 X 0 0 0 JENNIE REYES BOARD MEMBER 1.50 X 0 0 0 JONATHAN PETTEY BOARD MEMBER (THRU 01/16) 1.50 X 0 0 0 KERRY PRINCIPATO BOARD MEMBER (THRU 01/16) 1.50 X 0 0 0 MARGARET EMORY-LENFESTEY BOARD MEMBER (THRU 05/15) 1.50 X 0 0 0 DAVID B VLIET CHIEF EXECUTIVE OFFICER 40.00 X 212484 0 17250 YVONNE CAMARENA CHIEF OPERATIONS OFFICER 40.00 X 121261 0 10850 BRENT COPEN CHIEF FINANCIAL OFFICER 40.00 X 120308 0 17115 ANITHA L MULLANGI CHIEF MEDICAL OFFICER 40.00 X 226200 0 10625 SRIDEVI PONNALA CHIEF DENTAL OFFICER 40.00 X 186500 0 2330 OLGA KASHLINSKAYA PHYSICIAN 40.00 X 160931 0 1884 ANKITA SHRIVASTAVA PHYSICIAN 40.00 X 155096 0 1408 ORLANDO BARICAR PHYSICIAN 40.00 X 151147 0 10536 ARUN KULTHIA PHYSICIAN 40.00 X 154920 0 9292 NOE GUTIERREZ PHYSICIAN 40.00 X 116074 0 8706 1604921 0 89996 19 0 1 0 PRIORITY MANAGEMENT GROUP 700 SCHOOL STREET PAWTUCKET RI 02860 BILLING 765999 MCKESSON MEDICAL SURGICIAL PO BOX 634404 CINCINNATI OH 45263 MEDICAL SUPPLIES 670485 BAY CHILDREN'S PHYSICIANS 747 52ND STREET OAKLAND CA 94609 PHYSICIAN LOCUM TENENS 542434 QUEST DIAGNOSTICS PO BOX 515002 SACRAMENTO CA 95851 LABORATORY SERVICES 406336 HENRY SCHEIN INC PO BOX 7156 PASADENA CA 911097156 DENTAL SUPPLIES 199554 13 9740030 712761 10452791 PATIENT & THIRD PARTY 621300 14223365 14223365 CAPITATION REVENUE 621300 2486767 2486767 OTHER PROGRAM REVENUE 621300 349775 349775 17059907 71145 71145 5000 0 5000 5000 5000 80037 33908 46129 46129 BAD DEBT RECOVERY 900099 322754 322754 OTHER INCOME 900099 52755 52755 375509 28010481 17059907 0 497783 X 750 750 1159983 506846 653137 13695595 12297181 1398414 2133664 1805277 328387 1356480 1156179 200301 43616 43616 72762 60671 12091 3176733 2783818 392915 30022 23461 6561 724369 615136 109233 315808 218045 97763 1256338 850865 405473 90625 72817 17808 77099 50473 26626 433222 433222 228372 136826 91546 130297 375 129922 PROGRAM SUPPLIES 1157780 1157780 MISCELLANEOUS EXPENSES 140458 92790 47668 EQUIPMENT & MAINTENANCE 61197 61197 26285170 21829290 4455880 0 1370620 4047713 0 9872 1713064 2352599 1537781 983193 227086 148153 8746380 6780317 1918304 1966063 7003000 7003000 1590146 1251126 15360001 17761719 2215496 2611917 111742 776837 6799837 6546980 603326 471074 9730401 10406808 X 5593942 7273995 35658 80916 5629600 7354911 15360001 17761719 1725311 0 X X 0 1 X 1 1 1 X 10659646 12873729 11461538 10576830 10452791 56024534 10659646 12873729 11461538 10576830 10452791 56024534 5686919 50337615 1099 756 28005 77526 76145 183531 58939 318225 369885 498113 455546 1700708 57908773 60086827 0.86930 0.98640 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 20317 20317 3477959 2198050 1279909 5248104 4582267 665837 1966063 INVESTMENT IN NMTC TVHC FUND 7003000 F 7003000 INTERCOMPANY PREPAID EXPENSES 1251126 1251126 PPS SETTLEMENTS 471074 471074 X PART X, LINE 2: TVHC IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND FROM STATE INCOME TAX UNDER SECTION 23701(D) OF THE REVENUE AND TAXATION CODE OF THE STATE OF CALIFORNIA. ACCORDINGLY, CONTRIBUTIONS TO TVHC ARE QUALIFIED CHARITABLE CONTRIBUTION DEDUCTIONS. TVHC HAS EVALUATED ITS CURRENT TAX POSITIONS AND HAS CONCLUDED THAT AS OF JUNE 30, 2016, IT DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS FOR WHICH A RESERVE WOULD BE NECESSARY. TVHC FILES U.S. FEDERAL AND STATE RETURNS, AND IS GENERALLY NO LONGER SUBJECT TO TAX EXAMINATIONS FOR YEARS PRIOR TO 2012 AND 2011, RESPECTIVELY. TVHC FACILITIES, INC. AND TVHC FACILITIES II, INC. ARE QUALIFIED AS TAX EXEMPT ORGANIZATIONS. 45TH ANNIV. CELEBRATION 80037 80037 3337 15730 14841 80037 80037 3337 15730 14841 33908 46129 X 0 1 0 0 0 0 0 0 0 DAVID B VLIET CHIEF EXECUTIVE OFFICER 212484 0 0 0 0 0 5840 0 11410 0 229734 0 0 0 ANITHA L MULLANGI CHIEF MEDICAL OFFICER 226200 0 0 0 0 0 1040 0 9585 0 236825 0 0 0 SRIDEVI PONNALA CHIEF DENTAL OFFICER 186500 0 0 0 0 0 1040 0 1290 0 188830 0 0 0 OLGA KASHLINSKAYA PHYSICIAN 160931 0 0 0 0 0 1690 0 194 0 162815 0 0 0 ANKITA SHRIVASTAVA PHYSICIAN 155096 0 0 0 0 0 910 0 498 0 156504 0 0 0 ORLANDO BARICAR PHYSICIAN 151147 0 0 0 0 0 1546 0 8990 0 161683 0 0 0 ARUN KULTHIA PHYSICIAN 154920 0 0 0 0 0 1171 0 8121 0 164212 0 0 0 PART I, LINE 4B DURING FYE 06/30/16, DAVID B. VLIET PARTICIPATED IN AND CONTRIBUTED $4,800 TO A 457(B) CONTRIBUTION PLAN. FORM 990, PART VI, SECTION A, LINE 2 NANCY SOTO AND JESSE ROBLES HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11 THE TAX RETURN IS REVIEWED BY THE FINANCE COMMITTEE AND MADE AVAILABLE TO THE BOARD BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C ALL EMPLOYEES SIGN A FORM THAT SIGNIFIES RECEIPT AND UNDERSTANDING OF THE CONFLICT OF INTEREST POLICY UPON HIRE. THE HR DEPARTMENT MAKES SURE THAT NEW CONSULTANTS, VENDORS, & FUTURE EMPLOYEES ARE NOT RELATED TO ANY OF THE EMPLOYEES THAT HAVE A DIRECT BUSINESS RELATIONSHIP/TRANSACTION WITH ANY RELATIVE OF AN OFFICER, BOARD MEMBER OR EMPLOYEE IN A MANAGEMENT POSITION THAT WILL HAVE A DIRECT BENEFIT FROM THE TRANSACTION. THE CONFLICT OF INTEREST POLICY MONITORED BY A COMBINATION OF MANAGEMENT, SUPERVISORS, AND THE HUMAN RESOURCES DEPARTMENT. IF ANY INTERESTED PERSON HAS A CONFLICT OF INTEREST, IT IS THE DUTY OF THE INTERESTED PERSON TO REPORT IT. IF THE INTERESTED PERSON IS NOT ABLE TO MITIGATE THE CONFLICT OF INTEREST, MANAGEMENT WILL DETERMINE THE APPROPRIATE COURSE OF ACTION IN EITHER MITIGATING THE CONFLICT OF INTEREST OR DISMISSING THE INTERESTED PERSON. FORM 990, PART VI, SECTION B, LINE 15 THE HR OFFICER COMPARES THE COMPENSATIONS OF TVHC'S TOP MANAGEMENT OFFICIALS, DIRECTORS, AND STAFF TO THE STATE PRIMARY CARE ASSOCIATION TO MAKE SURE TVHC'S COMPENSATIONS ARE CLOSE TO MARKET. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,783,818. MANAGEMENT AND GENERAL EXPENSES 392,915. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,176,733. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. TVHC FACILITIES INC 22331 MISSION BLVD HAYWARD CA 945413911 270250766 SUPPORT TVHC'S DIRECT CHARITABLE & EDUCATIONAL ACTIVITIES CA 509(A)(3) LINE 11B, II TIBURCIO VASQUEZ HEALTH CENTER INC 0 TVHC FACILITIES II INC 22331 MISSION BLVD HAYWARD CA 945413911 463821919 SUPPORT TVHC'S DIRECT CHARITABLE & EDUCATIONAL ACTIVITIES CA 509(A)(3) LINE 11B, II TIBURCIO VASQUEZ HEALTH CENTER INC 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 TVHC FACILITIES INC A 15 CASH TVHC FACILITIES INC K 315000 CASH TVHC FACILITIES II INC K 171996 CASH