Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) .... | 8,444,725 | 5,175,848 | 5,352,376 | 6,375,860 | 9,713,470 | 35,062,279 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | 0 | |||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 4 | Total. Add lines 1 through 3 | 8,444,725 | 5,175,848 | 5,352,376 | 6,375,860 | 9,713,470 | 35,062,279 |
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | 0 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 35,062,279 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 8,444,725 | 5,175,848 | 5,352,376 | 6,375,860 | 9,713,470 | 35,062,279 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 11,292 | 8,481 | 9,484 | 8,083 | 11,025 | 48,365 |
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | 0 | |||||
| 11 | Total support. Add lines 7 through 10. | 35,189,649 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2015 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | 15000324 |
| Software Version: | 2015v2.0 |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Line 11b: Form 990 Review Process | THE FORM 990 PREPARER PROVIDES A DRAFT COPY OF THE FORM 990 TO THE CFO AND THE ACCOUNTING COORDINATOR. A COPY OF THE FORM 990 IS ALSO PROVIDED TO THE FINANCE/AUDIT COMMITTEE FOR REVIEW; THE BOARD IS NOTIFIED OF ANY FINDINGS. AFTER REVIEW, THE FORM 990 PREPARER IS NOTIFIED TO FILE THE FORM 990. A REPORT IS THEN PROVIDED TO THE FULL BOARD OF DIRECTORS ON THE RESULTS OF THE FORM 990. |
| Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | CONFLICT OF INTEREST PROCEDURES: PERSONS CONCERNED: THIS STATEMENT IS DIRECTED NOT ONLY TO DIRECTORS AND OFFICERS, BUT ALSO TO ALL EMPLOYEES WHO CAN INFLUENCE THE ACTIONS OF LA CLINICA DEL VALLE. FOR EXAMPLE, THIS WOULD INCLUDE ALL WHO MAKE PURCHASING DECISIONS, ALL OTHER PERSONS WHO MIGHT BE DESCRIBED AS "MANAGEMENT PERSONNEL," AND ALL WHO HAVE PROPRIETARY INFORMATION CONCERNING LA CLINICA DEL VALLE.AREAS IN WHICH CONFLICT MAY ARISE: CONFLICTS OF INTEREST MAY ARISE IN THE RELATIONS OF DIRECTORS, OFFICERS, AND MANAGEMENT EMPLOYEES WITH ANY OF THE FOLLOWING THIRD PARTIES:1. PERSONS AND FIRMS SUPPLYING GOODS AND SERVICES TO LA CLINICA DEL VALLE.2. PERSONS AND FIRMS FROM WHOM LA CLINICA DEL VALLE LEASES PROPERTY AND EQUIPMENT.3. PERSONS AND FIRMS WITH WHOM LA CLINICA DEL VALLE IS DEALING OR PLANNING TO DEAL IN CONNECTION WITH THE GIFT, PURCHASE OR SALE OF REAL ESTATE, SECURITIES, OR OTHER PROPERTY.4. COMPETING OR AFFINITY ORGANIZATIONS.5. DONORS AND OTHERS SUPPORTING LA CLINICA DEL VALLE.6. AGENCIES, ORGANIZATIONS, AND ASSOCIATIONS, WHICH AFFECT THE OPERATIONS OF LA CLINICA DEL VALLE.7. FAMILY MEMBERS, FRIENDS, AND OTHER EMPLOYEES.DISCLOSURE PROCEDURE: DISCLOSURE SHOULD BE MADE ACCORDING TO LA CLINICA DEL VALLE'S STANDARDS. TRANSACTIONS WITH RELATED PARTIES MAY BE UNDERTAKEN ONLY IF ALL OF THE FOLLOWING ARE OBSERVED:1. A MATERIAL TRANSACTION IS FULLY DISCLOSED IN THE AUDITED FINANCIAL STATEMENTS OF THE ORGANIZATION;2. THE RELATED PARTY IS EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTIONS;3. A COMPETITIVE BID OR COMPARABLE VALUATION EXISTS; AND4. THE ORGANIZATION'S BOARD HAS ACTED UPON AND DEMOSTRATED THAT THE TRANSACTION IS IN THE BEST INTEREST OF THE ORGANIZATION.DISCLOSURE IN THE ORGANIZATION SHOULD BE MADE TO THE CEO ( OR IF SHE OR HE IS THE ONE WITH THE CONFLICT, THEN TO THE BOARD CHAIR), WHO SHALL DETERMINE WHETHER A CONFLICT EXISTS AND IS MATERIAL, AND IF THE MATTERS ARE MATERIAL, BRING THEM TO THE ATTENTION OF THE BOARD CHAIR.DISCLOSURE INVOLVING DIRECTORS SHOULD BE MADE TO THE BOARD CHAIR, WHICH SHALL BRING THESE MATTERS, IF MATERIAL TO THE BOARD. THE BOARD SHALL DETERMINE WHETHER A CONFLICT EXISTS AND IS MATERIAL, AND IN THE PRESENCE OF AN EXISTING MATERIAL CONFLICT, WHETHER THE CONTEMPLATED TRANSACTION MAY BE AUTHORIZED AS JUST, FAIR, AND REASONABLE TO LA CLINICA DEL VALLE. THE DECISION OF THE BOARD ON THESE MATTERS WILL REST IN THEIR SOLE DISCRETION, AND THEIR CONCERN MUST BE THE WELFARE OF LA CLINICA DEL VALLE AND THE ADVANCEMENT OF ITS PURPOSE. |
| Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management | THE BOARD OF DIRECTORS ARE RESPONSIBLE TO HIRE AND REMOVE THE CHIEF EXECUTIVE OFFICER, SUPPORT AND ASSESS HIS OR HER PERFORMANCE, AND ENSURE THAT THE CHIEF EXECUTIVE HAS THE MORAL AND PROFESSIONAL SUPPORT NEEDED TO FURTHER THE GOALS OF THE ORGANIZATION.EACH YEAR A MARKET REVIEW IS PERFORMED FOR A COMPETITIVE ANALYSIS OF SALARIES IN THE LOCAL AND REGIONAL AREAS FOR THE CEO AND THE HUMAN RESOURCE DIRECTOR INFORMS THE BOARD CHAIR OF ANY RELEVANT PAY CHANGES THAT ARE DUE TO OCCUR. NEXT, THE EXECUTIVE COMMITTEE MEETS TO DISCUSS THE PAY CHANGE AND A VOTE IS HELD IN JUNE TO ADOPT THE PAY CHANGE OR NOT DEPENDING UPON THE BUDGETED FINANCIAL FORECAST OF THE ORGANIZATION. |
| Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | EACH YEAR A MARKET REVIEW IS PERFORMED FOR A COMPETITIVE ANALYSIS OF SALARIES IN THE LOCAL AND REGIONAL AREAS FOR ALL POSITIONS IN THE ORGANIZATION. THE HUMAN RESOURCE DIRECTOR COMPILES THE INFORMATION, AND AFTER APPROVAL FROM THE CEO, IT IS GIVEN TO THE ACCOUNTING COORDINATOR WHO INPUTS THE DATA INTO THE FORECASTED BUDGET FOR THE NEXT FISCAL YEAR. INCREASES IN BASE PAY MAY BE INCLUDED FOR NEW BUDGET PERIODS (BEGINNING IN JUNE) IF THE FOLLOWING IS TRUE:1. FINANCIAL FORECAST FOR THE ORGANIZATION IS HEALTHY;2. IF THE SALARY FOR THE JOB POSITION HAS FALLEN BELOW THE AVERAGE MARKET RANGE AND PAY THRESHOLD FOR THE ORGANIZATION;3. THE BOARD OF DIRECTORS HAS REVIEWED AND APPROVED THE NEW BUDGET INCLUDING THE CHANGES TO SALARIES AND WAGES. |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | LA CLINICA DEL VALLE MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AS PER THE FOLLOWING POLICY GUIDELINES:THE AUDITED FINANCIAL STATEMENTS WILL BE DISTRIBUTED TO THE BOARD OF DIRECTORS, TO REGULATORY AGENCIES AND TO ORGANIZATIONS ENTITLED TO RECEIVE A COPY DUE TO CONTRACTUAL AGREEMENT. THE AUTHORITY TO DISTRIBUTE THE STATEMENTS TO OTHER INDIVIDUALS OR FIRMS REQUESTING THEM WILL BE LEFT TO THE DISCRETION OF THE CHIEF EXECUTIVE OFFICER AND THE CHIEF FINANCIAL OFFICER. |
| FORM 990, PART I, LINE 1 - ORG. MISSION | TO ESTABLISH A COMPREHENSIVE FAMILY ORIENTED QUALITY HEALTH CARE CENTER WHICH PROVIDES FOR AGRICULTURAL WORKERS AND OTHER MEDICALLY UNDERSERVED IN JACKSON COUNTY. THE MISSION OF LA CLINICA IS TO PROVIDE QUALITY MEDICAL, DENTAL AND SOCIAL SERVICES TO THE DIVERSE POPULATIONS WITHIN OUR COMMUNITIES, ESPECIALLY THOSE WHO FACE BARRIERS TO HEALTHCARE. |
| Software ID: | 15000324 |
| Software Version: | 2015v2.0 |